Using a pocket card to improve end-of-life care on internal medicine clinical teaching units: a cluster-randomized controlled trial.
BACKGROUND
End-of-life care is suboptimally taught in undergraduate and postgraduate education in Canada. Previous interventions to improve residents' knowledge and comfort have involved lengthy comprehensive educational modules or dedicated palliative care rotations.


OBJECTIVE
To determine the effectiveness of a cheap, portable, and easily implemented pocket reference for improving residents' knowledge and comfort level in dealing with pain and symptom management on the medical ward.


METHODS
Cluster-randomized controlled trial conducted from August 2005 to June 2006.


METHODS
Medical clinical teaching units (CTUs) in 3 academic hospitals in Toronto, Canada.


METHODS
All residents rotating through the medical CTUs who consented to participate in the study.


METHODS
Residents at 1 hospital received a pocket reference including information about pain and symptom control, as well as 1-2 didactic end-of-life teaching sessions per month normally given as part of the rotation. Residents at the other 2 hospitals received only the didactic sessions.


METHODS
A 10-question survey assessing knowledge and comfort level providing end-of-life care to medical inpatients, as well as focus group interviews.


RESULTS
One hundred thirty-six residents participated on 3 CTUs for a participation rate of approximately 75%. Comfort levels improved in both control (p < .01) and intervention groups (p < .01), but the increase in comfort level was significantly higher in the intervention group (z = 2.57, p < .01). Knowledge was not significantly improved in the control group (p = .06), but was significantly improved in the intervention group (p = .01). Greater than 90% of residents in the intervention group used the card at least once per week, and feedback from the focus groups was very positive.


CONCLUSIONS
Our pocket card is a feasible, economical, and educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on CTUs.
Mikhael
Joseph
J
Division of Hematology-Oncology, Mayo Clinic, Arizona 85259, USA. mikhael.joseph@mayo.edu
Baker
Lindsay
L
Downar
James
J
D016000:Cluster Analysis; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D009864:Ontario; D018709:Statistics, Nonparametric; D011795:Surveys and Questionnaires; D013664:Teaching Materials; D013727:Terminal Care