title: Experiences in end-of-life care in the Intensive Care Unit: A survey of resident physicians.
abstract: OBJECTIVE
  The practice of intensive care includes withholding and withdrawal of care, when appropriate, and the goals of care change around this time to comfort and palliation. We decided to survey the attitudes, training, and skills of intensive care residents in relation to end-of-life (EoL) care. All residents at our institute who has worked for at least a month in an adult Intensive Care Unit were invited to participate.
  
  
  METHODS
  After Institutional Ethics Committee approval, a Likert-scale questionnaire, divided into five composite measures of EoL skills including training and attitude, was handed over to individual residents and completed data were anonymized. Frequency and descriptive analysis was performed for the demographic variables. Central tendency, variability, and reliability were examined for the five composite measures. Scale internal consistency was checked by Cronbach's coefficient alpha. Multivariate forward conditional regression analysis was conducted to examine the association of demographic data or EoL experience to composite measures.
  
  
  RESULTS
  Of the 170 eligible residents, we received 120 (70.5%) responses.
  
  
  CONCLUSIONS
  Internal medicine residents have more experience in caring for dying patients and conducting EoL discussions. Even though majority of participants reported that they are comfortable with the concept of EoL care, this does not always reflect the actual practice in the hospital. There is a need for further training in skills around EoL care. As this is a self-assessment survey, the specific measures of attitudes and skills in EoL are poorly reflected, indicating a need for further research.
authors.affiliation: Department of Organ Transplant Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Zubair Umer
authors.initials: ZU
authors.lastname: Mohamed
authors.affiliation: Department of Organ Transplant Anaesthesia and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Fazil
authors.initials: F
authors.lastname: Muhammed
authors.affiliation: Department of Pain and Palliative Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Charu
authors.initials: C
authors.lastname: Singh
authors.affiliation: Department of Pediatric Cardiology, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Abish
authors.initials: A
authors.lastname: Sudhakar
keywords: End-of-life; intensive care; palliative care