Attitudes about end-of-life care: a national cross-sectional study.
BACKGROUND
Major concerns have been expressed about the preparation of physicians to provide end-of-life care. Little is known about how well academic health centers prepare students and residents to care for patients at the end-of-life and about the values about end-of-life care transmitted by faculty.


METHODS
In 1997, we conducted a telephone survey of a nationally representative sample of first-year medical students (n = 287), fourth-year medical students (n = 173), residents (n = 473), clinical faculty (n = 728), internal medicine residency training directors (n = 143), department chairs (n = 186), and medical school deans (n = 101) within U.S. academic health centers (response rate = 80.2%).


RESULTS
U.S. medical students, residents and faculty evaluate themselves as inadequately prepared to provide end-of-life care. Academic health center constituents perceive that providing care at the end of life requires medium to high levels of expertise. Academic health center constituents are divided about whether responsibility for providing care at the end of life rests with generalists or with specialists and view managed care as nearly equivalent to the fee-for-service sector in its capacity to provide excellent end-of-life care.


CONCLUSIONS
Academic leaders and faculty, as well as their students, lack confidence in their own skills in providing end-of-life care. They also question the ability of the current and evolving health care delivery system to provide excellent end-of-life care.
Block
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Division of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Sullivan
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AM