title: Physician experience caring for dying patients and its relationship to patient outcomes.
abstract: BACKGROUND
  The quality of end-of-life care has become important to care systems and the public. No research has assessed how physician factors affect patient and family experience.
  
  
  OBJECTIVE
  The objective of this study was to examine whether physicians' experience with dying is associated with differences in their patients' experiences while dying.
  
  
  METHODS
  This was a prospective cohort study. Data were obtained from five geographically diverse teaching hospitals. The survey population was composed of 765 attending physicians who had at least one patient enrolled in a study of those with a high risk of dying. The patients were 8203 hospitalized adults who were at least 80 years of age or had one of nine serious illnesses. The physician survey provided information about physician characteristics. Physician experience with death was stratified into five groups according to self-reported rate of dying patients in the physician's practice. Patient outcomes included pain, anxiety, depression, satisfaction with pain relief, presence and timing of do-not-resuscitate orders, concordance with their physicians about cardiopulmonary resuscitation, and hospital resource use.
  
  
  RESULTS
  Oncologists and pulmonologists or critical care physicians had more frequent contact with death. Physician characteristics other than specialty were not associated with death experience. Compared with the physician group having no experience with death, the adjusted odds ratios for accord on resuscitation preferences were 1.38 (95% confidence interval [CI], 0.96 to 1.98), 1.47 (95% CI, 1.03 to 2.11), 1.58 (95% CI, 1.10 to 2.26), and 1.64 (95% CI, 1.09 to 2.46) for the other four physician groups with progressively increasing experience. Other outcomes for patients were not associated with increasing physician experience.
  
  
  CONCLUSIONS
  Most physicians have little experience with dying, and physicians' experience with death has little effect on patient outcomes. The concentration of experience in a small segment of physicians offers opportunities for targeting improvements in the care of dying patients, including physician education.
authors.affiliation: Center to Improve Care of the Dying, The George Washington University, Washington, DC 20037, USA. IHOJJL@gwumc.edu
authors.forename: J
authors.initials: J
authors.lastname: Lynn
authors.forename: Z
authors.initials: Z
authors.lastname: Zhong
authors.forename: N V
authors.initials: NV
authors.lastname: Dawson
authors.forename: A F
authors.initials: AF
authors.lastname: Connors
authors.forename: R S
authors.initials: RS
authors.lastname: Phillips