title: Physicians in Postgraduate Training Characteristics and Support of Palliative Sedation for Existential Distress.
abstract: BACKGROUND
  Palliative sedation for refractory existential distress (PS-ED) is ethically troubling but potentially critical to quality end-of-life (EOL) care. Physicians' in postgraduate training support toward PS-ED is unknown nor is it known how empathy, hope, optimism, or intrinsic religious motivation (IRM) affect their support. These knowledge gaps hinder efforts to support physicians who struggle with patients' EOL care preferences.
  
  
  METHODS
  One hundred thirty-four postgraduate physicians rated their support of PS for refractory physical pain (PS-PP) or PS-ED, ranked the importance of patient preferences in ethically challenging situations, and completed measures of empathy, hope, optimism, and IRM. Predictors of PS-ED and PS-PP support were examined using binary and multinomial logistic regression.
  
  
  RESULTS
  Only 22.7% of residents were very supportive of PS-ED, and 82.0% were very supportive of PS-PP. Support for PS-PP or PS-ED did not correlate with levels of empathy, hope, optimism, or IRM; however, for residents with lower IRM, greater optimism was associated with greater PS-ED support. In contrast, among residents with higher IRM, optimism was not associated with PS-ED support.
  
  
  CONCLUSIONS
  Comparing current results to published surveys, a similar proportion of residents and practicing physicians support PS-ED and PS-PP. In contrast to practicing physicians, however, IRM does not directly influence residents' supportiveness. The interaction between optimism and IRM suggests residents' beliefs and characteristics are salient to their EOL decisions. End-of-life curricula should provide physicians opportunities to reflect on the personal and ethical factors that influence their support for PS-ED.
authors.affiliation: 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.|2 IU Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
authors.forename: Larry D
authors.initials: LD
authors.lastname: Cripe
authors.affiliation: 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.|2 IU Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Perkins
authors.affiliation: 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.
authors.forename: Ann
authors.initials: A
authors.lastname: Cottingham
authors.affiliation: 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.
authors.forename: Yan
authors.initials: Y
authors.lastname: Tong
authors.affiliation: 3 Purdue University School of Pharmacy, West Lafayette, IN, USA.
authors.forename: Mary Ann
authors.initials: MA
authors.lastname: Kozak
authors.affiliation: 1 Indiana University (IU) School of Medicine, Indianapolis, IN, USA.|2 IU Melvin and Bren Simon Cancer Center, Indianapolis, IN, USA.
authors.forename: Rakesh
authors.initials: R
authors.lastname: Mehta
mesh_terms: D001291:Attitude of Health Personnel; D054810:Deep Sedation / Q000523:psychology*; D004645:Empathy; D005086:Existentialism; D005260:Female; D006801:Humans; D007396:Internship and Residency; D016015:Logistic Models; D008297:Male; D000067656:Optimism; D010148:Intractable Pain / Q000188:drug therapy*; D010166:Palliative Care / Q000379:methods*; D010820:Physicians / Q000523:psychology*; D013315:Stress, Psychological / Q000188:drug therapy*; D013727:Terminal Care / Q000379:methods
keywords: end-of-life care; existential distress; healthcare provider characteristics; palliative sedation; patient preferences; postgraduate medical curriculum; religiosity