title: Regulatory and educational initiatives fail to promote discussions regarding end-of-life care.
abstract: We conducted an observational cohort study to determine if hospital-based, reinforcing regulatory and educational interventions could encourage physicians to discuss end-of-life (EOL) care with their patients. Specifically, we measured the effect of (1) administrative prompts to encourage discussions about EOL care and (2) a mandatory educational seminar focusing on EOL issues. Study subjects were patients consecutively admitted to the medicine service who faced an anticipated 3-year mortality rate of at least 50%. The main study endpoint was the frequency of documented EOL discussions between physicians and patients. In the inception cohort of 184 patients, physicians discussed EOL care with 64 patients (34. 8%), and in the follow-up cohort of 121 patients, 41 individuals (33. 9%) had documented discussions regarding EOL issues (P = 0.90). Actual "Do Not Resuscitate"(DNR) orders were written for 53 patients (28.8%) in the inception cohort and for 33 persons (27.3%) in the follow-up cohort (P = 0.71). We conclude that enhanced, mutually reinforcing regulatory and educational efforts focusing on EOL care proved ineffectual at promoting either discussions about EOL issues or the use of DNR orders.
authors.affiliation: Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: A F
authors.initials: AF
authors.lastname: Shorr
authors.forename: A S
authors.initials: AS
authors.lastname: Niven
authors.forename: D E
authors.initials: DE
authors.lastname: Katz
authors.forename: J M
authors.initials: JM
authors.lastname: Parker
authors.forename: A H
authors.initials: AH
authors.lastname: Eliasson
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003142:Communication; D004501:Education, Medical; D005260:Female; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D016414:Resuscitation Orders; D013727:Terminal Care / Q000331:legislation & jurisprudence / Q000592:standards*