title: Physicians' and Nurse Practitioners' Level of Pessimism About End-of-Life Care During Training: Does It Change Over Time?
abstract: An enhanced understanding of trainee attitudes about end-of-life care is needed to inform interventions to improve clinician communication about dying and death.
  
  
  
  To examine changes in trainee pessimism about end-of-life care over the course of one academic year and to explore predictors of pessimism among residents, fellows, and nurse practitioners.
  
  
  
  We used baseline and follow-up surveys completed by trainees during a randomized controlled trial of an intervention to improve clinician communication skills. Surveys addressed trainee feelings about end-of-life care. Latent variable modeling was used to identify indicators of trainee pessimism, and this pessimism construct was used to assess temporal changes in trainee attitudes about end-of-life care. We also examined predictors of trainee pessimism at baseline and follow-up. Data were available for 383 trainees from two training programs.
  
  
  
  There was a significant decrease in pessimism between baseline and follow-up assessments. Age had a significant inverse effect on baseline pessimism, with older trainees being less pessimistic. There was a direct association of race/ethnicity on pessimism at follow-up, with greater pessimism among minority trainees (P = 0.028). The model suggests that between baseline and follow-up, pessimism among younger white non-Hispanic trainees decreased, whereas pessimism among younger trainees in racial/ethnic minorities increased over the same period.
  
  
  
  Overall, trainee pessimism about end-of-life care decreases over time. Pessimism about end-of-life care among minority trainees may reflect the influence of culture on clinician attitudes about communication with seriously ill patients. Further research is needed to understand the evolution of trainee attitudes about end-of-life care during clinical training.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA. Electronic address: along11@uw.edu.
authors.forename: Ann C
authors.initials: AC
authors.lastname: Long
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
authors.forename: Lois
authors.initials: L
authors.lastname: Downey
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA.
authors.forename: Dee W
authors.initials: DW
authors.lastname: Ford
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
authors.forename: Anthony L
authors.initials: AL
authors.lastname: Back
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA.
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000367:Age Factors; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016018:Least-Squares Analysis; D008297:Male; D008875:Middle Aged; D009722:Nurse Practitioners / Q000193:education / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology; D000067657:Pessimism; D010820:Physicians / Q000523:psychology*; D013727:Terminal Care / Q000523:psychology*; D013997:Time Factors; D055815:Young Adult
keywords: Medical residency; attitude; internship; palliative care; trainee
references.citation: Acad Med. 2009 Nov;84(11):1533-9
references.pmid: 19858811
references.citation: J Palliat Med. 2014 Jan;17(1):80-4
references.pmid: 24410421
references.citation: J Palliat Med. 2014 Feb;17(2):159-66
references.pmid: 24180700
references.citation: J Palliat Med. 2009 May;12(5):459-70
references.pmid: 19416043
references.citation: J Palliat Med. 2003 Jun;6(3):391-9
references.pmid: 14509484
references.citation: Acad Med. 2009 Feb;84(2):269-77
references.pmid: 19174684
references.citation: JAMA. 2013 Dec 4;310(21):2271-81
references.pmid: 24302090
references.citation: J Palliat Med. 2011 Jan;14(1):59-64
references.pmid: 21244255
references.citation: J Oncol Pract. 2015 Jul;11(4):289-95
references.pmid: 26060222
references.citation: Intern Med J. 2004 Sep-Oct;34(9-10):578-80
references.pmid: 15482274
references.citation: J Am Geriatr Soc. 2002 Jan;50(1):182-90
references.pmid: 12028266
references.citation: Acad Med. 2005 Jul;80(7):617-21
references.pmid: 15980077
references.citation: Patient Educ Couns. 2010 Jul;80(1):3-9
references.pmid: 19948388
references.citation: J Palliat Med. 2013 Aug;16(8):941-6
references.pmid: 23786426
references.citation: J Am Geriatr Soc. 1999 May;47(5):579-91
references.pmid: 10323652
references.citation: J Palliat Med. 2008 Nov;11(9):1227-33
references.pmid: 19021486
references.citation: J Palliat Med. 1998 Winter;1(4):347-55
references.pmid: 15859853
references.citation: Nephrol Dial Transplant. 2011 Dec;26(12):3838-42
references.pmid: 22121239
references.citation: J Gen Intern Med. 2009 Jun;24(6):695-701
references.pmid: 19387750
references.citation: Acad Med. 2005 Jul;80(7):622-33
references.pmid: 15980078
references.citation: J Palliat Med. 2010 Mar;13(3):319-26
references.pmid: 20178433
references.citation: Acad Med. 2004 Aug;79(8):760-8
references.pmid: 15277133
references.citation: Crit Care Med. 2003 May;31(5 Suppl):S373-8
references.pmid: 12771586