title: Physicians' ratings of their knowledge, attitudes, and end-of-life-care practices.
abstract: OBJECTIVE
  Health care institutions are examining ways to improve physicians' skills in the delivery of end-of-life (EOL) care. Experts have suggested that influencing physicians' knowledge and attitudes concerning EOL care can influence subsequent EOL practices, including hospice use for appropriate patients; yet few studies have examined empirically the influence of physicians' knowledge and attitudes on such practices. The authors assessed the influences of self-rated knowledge and attitudes on physicians' discussions and referrals for hospice care.
  
  
  METHODS
  In 1998 and 1999 the authors conducted a cross-sectional study of physicians affiliated with six randomly selected community hospitals in Connecticut with more than 200 licensed medical and surgical beds. Physicians completed a self-administered questionnaire (response rate 52.4%) that assessed self-rated knowledge of terminal care and hospice, a set of attitudinal items, and practices related to hospice discussion and referrals, as well as standard sociodemographic data. Bivariate and multivariate analyses were conducted.
  
  
  RESULTS
  Self-rated knowledge was significantly associated with referral practices in unadjusted analyses (unadjusted odds ratio [OR]: 0.70; 95% confidence interval [CI]: 0.52, 0.95), although this association was attenuated in adjusted analyses by specialty and other physicians' characteristics (adjusted OR: 0.80; 95% CI: 0.55, 1.18). Attitudes representing support for hospice practices and philosophy were associated with referral practices in adjusted and unadjusted analyses (adjusted OR:0.52; 95% CI: 0.35, 0.77).
  
  
  CONCLUSIONS
  This study demonstrated that self-rated knowledge and attitudes may influence hospice referral. The results support current efforts to develop medical school curricula and continuing education programs that better cover the many aspects of caring for the dying, including hospice use.
authors.affiliation: Department of Epidemiology and Public Health, Yale University School of Medicine, 60 College Street, New Haven, CT 06520, USA. elizabeth.bradley@yale.edu
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
authors.forename: Laura D
authors.initials: LD
authors.lastname: Cramer
authors.forename: Sidney T
authors.initials: ST
authors.lastname: Bogardus
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Rosemary
authors.initials: R
authors.lastname: Johnson-Hurzeler
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Horwitz
mesh_terms: D000328:Adult; D003142:Communication; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006738:Hospices; D006801:Humans; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians; D012017:Referral and Consultation; D013727:Terminal Care