title: Communication About Advance Directives and End-of-Life Care Options Among Internal Medicine Residents.
abstract: BACKGROUND
  Despite increasing awareness about the importance of discussing end-of-life (EOL) care options with terminally ill patients and families, many physicians remain uncomfortable with these discussions.
  
  
  OBJECTIVE
  The objective of the study was to examine perceptions of and comfort with EOL care discussions among a group of internal medicine residents and the extent to which comfort with these discussions has improved over time.
  
  
  METHODS
  In 2013, internal medicine residents at a large academic medical center were asked to participate in an on-line survey that assessed their attitudes and experiences with discussing EOL care with terminally-ill patients. These results were compared to data from a similar survey residents in the same program completed in 2006.
  
  
  RESULTS
  Eighty-three (50%) residents completed the 2013 survey. About half (52%) felt strongly that they were able to have open, honest discussions with patients and families, while 71% felt conflicted about whether CPR was in the patient's best interest. About half (53%) felt strongly that it was okay for them to tell a patient/family member whether or not CPR was a good idea for them. Compared to 2006 respondents, the 2013 cohort felt they had more lectures about EOL communication, and had watched an attending have an EOL discussion more often.
  
  
  CONCLUSIONS
  Modest improvements were made over time in trainees' exposure to EOL discussions; however, many residents remain uncomfortable and conflicted with having EOL care discussions with their patients. More effective training approaches in EOL communication are needed to train the next generation of internists.
authors.affiliation: Division of Geriatrics, UT Southwestern Medical Center, Dallas, TX, USA ramona.rhodes@UTSouthwestern.edu.
authors.forename: Ramona L
authors.initials: RL
authors.lastname: Rhodes
authors.affiliation: Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Kate
authors.initials: K
authors.lastname: Tindall
authors.affiliation: Division of Outcomes and Health Services Research, Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Lei
authors.initials: L
authors.lastname: Xuan
authors.affiliation: Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: M Elizabeth
authors.initials: ME
authors.lastname: Paulk
authors.affiliation: Division of Outcomes and Health Services Research, Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA Division of General Internal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
mesh_terms: D000328:Adult; D016223:Advance Directives; D003142:Communication; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D008297:Male; D010817:Physician-Patient Relations; D013727:Terminal Care / Q000523:psychology*
keywords: advance directives; hospice; internal medicine residents; medical education; palliative care; patient–physician communication