Is empathy associated with a self-ascribed sense of meaning among resident physicians working with patients nearing the end of life on a hematology-oncology ward?

28 Background: An association between empathy and physician-in-training based meaning derived from patient deaths has not been explored previously. If meaning is associated with empathy, an intervention to enhance meaning may counteract empathy decline and promote clinician resilience. This study sought to understand if empathy might be associated with the ability to find meaning in the clinical situations that residents face in oncology. Methods: Internal Medicine residents rotating on a Hematology/Oncology ward were asked “Do you derive a sense of meaning from working with dying patients? Yes or No.” The Interpersonal-Reactivity Index (IRI) was used to measure empathy and demographic information. Results: 64 responded (66.7% response rate). 43 (67.2%) derived a sense of meaning while 21 (32.8%) did not. The ‘meaning’ group empathy score (IRI) was 60.7 (SD 10.8) and the ‘no meaning’ group empathy score (IRI) was 51.7 (SD 11.5) (p < .01). Empathy subscale differences were notable for decreased cognitive empathy via the Fantasy Score (14.0 versus 9.9) (p < .01) and decreased affective empathy via the Empathic Concern scale (18.8 versus 15.9) (p < .05). Conclusions: The majority of physicians-in-training derived a sense of meaning from working with patients at the end of life and had significantly higher levels of empathy. The ability to impart meaning-finding has been demonstrated in patients and could be taught to physicians-in-training and lead to higher empathy levels. [Table: see text]

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Improving the End-of-Life Experience for Family Members of Cancer Patients Who Die on the Oncology Ward: The Three Wishes Project (SCI922)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2021.01.085 ◽

2021 ◽

Vol 61 (3) ◽

pp. 681-682

Author(s):

Gwenyth Day ◽

Marilyn Swinton ◽

Danielle Bear ◽

Peter Phung ◽

Allegra Bell ◽

...

Keyword(s):

End Of Life ◽

Cancer Patients ◽

Life Experience ◽

Family Members ◽

Oncology Ward

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Discussion and documentation of future care: a before-and-after study examining the impact of an alternative approach to recording treatment decisions on advance care planning in an acute hospital

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2016-001101 ◽

2017 ◽

Vol 10 (2) ◽

pp. e12-e12 ◽

Cited By ~ 2

Author(s):

Alexandra C Malyon ◽

Julia R Forman ◽

Jonathan P Fuld ◽

Zoë Fritz

Keyword(s):

End Of Life ◽

Advance Care Planning ◽

Treatment Decisions ◽

Care Planning ◽

New Approach ◽

Significance Level ◽

Oncology Ward ◽

Future Care ◽

Advance Care ◽

The Impact

ObjectiveTo determine whether discussion and documentation of decisions about future care was improved following the introduction of a new approach to recording treatment decisions: the Universal Form of Treatment Options (UFTO).MethodsRetrospective review of the medical records of patients who died within 90 days of admission to oncology or respiratory medicine wards over two 3-month periods, preimplementation and postimplementation of the UFTO. A sample size of 70 per group was required to provide 80% power to observe a change from 15% to 35% in discussion or documentation of advance care planning (ACP), using a two-sided test at the 5% significance level.ResultsOn the oncology ward, introduction of the UFTO was associated with a statistically significant increase in cardiopulmonary resuscitation decisions documented for patients (pre-UFTO 52% to post-UFTO 77%, p=0.01) and an increase in discussions regarding ACP (pre-UFTO 27%, post-UFTO 49%, p=0.03). There were no demonstrable changes in practice on the respiratory ward. Only one patient came into hospital with a formal ACP document.ConclusionsDespite patients’ proximity to the end-of-life, there was limited documentation of ACP and almost no evidence of formalised ACP. The introduction of the UFTO was associated with a change in practice on the oncology ward but this was not observed for respiratory patients. A new approach to recording treatment decisions may contribute to improving discussion and documentation about future care but further work is needed to ensure that all patients’ preferences for treatment and care at the end-of-life are known.

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Advanced Care Planning and End-of-Life Discussions Amongst Resident Physicians In the Primary Care Setting (TH341C)

Journal of Pain and Symptom Management ◽

10.1016/j.jpainsymman.2017.12.047 ◽

2018 ◽

Vol 55 (2) ◽

pp. 582-583

Author(s):

Suraj Tandon

Keyword(s):

Primary Care ◽

End Of Life ◽

Care Setting ◽

Primary Care Setting ◽

Care Planning ◽

Advanced Care Planning ◽

Resident Physicians

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Dying for advice: Code-status discussions between resident physicians and patients with advanced cancer—A national survey.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.31_suppl.83 ◽

2014 ◽

Vol 32 (31_suppl) ◽

pp. 83-83

Author(s):

David Johnson Einstein ◽

Katherine Levine Einstein ◽

Paul Mathew

Keyword(s):

Internal Medicine ◽

United States ◽

End Of Life ◽

Advanced Cancer ◽

Patient Autonomy ◽

The United States ◽

Specific Recommendation ◽

Code Status ◽

Resident Physicians ◽

Treatment Refractory

83 Background: Patients with treatment-resistant advanced cancer rarely benefit from cardiopulmonary resuscitation (CPR) but infrequently discuss end-of-life care with a physician until hospitalized for deterioration. Admitting resident physicians may therefore conduct initial code-status discussions, but may elicit patients’ preferences without providing necessary guidance. Methods: We distributed a case-based survey to all United States internal medicine residency program directors, of whom 19 enrolled and forwarded the survey to their residents. 358 residents (response rate 22.0%) completed the survey. Results: Faced with a hypothetical case of an inpatient with treatment-refractory advanced cancer, nearly all residents felt CPR would not be helpful. Yet, fewer than half (46.7%) of residents were likely to discuss an estimate of prognosis and the value of CPR with the patient. Only 30% were likely to offer a specific recommendation on CPR. A majority (69%) of residents who were unwilling to make a recommendation stated that patients should make their decisions independently. Most residents report that a sense of responsibility is the primary reason to discuss code status independent of attending physicians, and that deference to patient autonomy prevented them from sharing knowledge of outcomes or offering guidance. Ultimately, a minority stated they were satisfied with end-of-life discussions. Conclusions: Internal medicine resident physicians in the United States are unlikely to share the poor prognosis or offer specific recommendations on CPR in treatment-refractory cancer principally because of a conflict with their concept of patient autonomy. Given the futility associated with CPR in this setting, these data define a major unmet need in training and practice.

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Advanced Care Directives: Overcoming the Obstacles

Journal of Graduate Medical Education ◽

10.4300/jgme-d-14-00145.1 ◽

2015 ◽

Vol 7 (1) ◽

pp. 91-94 ◽

Cited By ~ 10

Author(s):

Sarah Leatherman Allen ◽

Kimberly S. Davis ◽

Paul C. Rousseau ◽

Patty J. Iverson ◽

Patrick D. Mauldin ◽

...

Keyword(s):

End Of Life ◽

Internal Medicine Resident ◽

Living Will ◽

Clinical Environment ◽

Family Meeting ◽

Continuity Clinic ◽

Medicine Resident ◽

Resident Physicians ◽

Advanced Care Directives ◽

Resident Continuity Clinic

Abstract Background Advanced care directives (ACDs) and end-of-life discussions are important and typically difficult to initiate because of the sensitive nature of the topic and competing clinical priorities. Resident physicians need to have these conversations but often do not in their continuity clinics. Objective We implemented a program to (1) increase physician opportunity to discuss end-of-life wishes with their patients, and (2) improve residents' confidence in leading discussions regarding ACDs. Intervention A total of 95 residents in an academic outpatient internal medicine resident continuity clinic participated in a formalized curriculum (didactic sessions, simulations, and academic detailing). Clinic workflow alterations prompted the staff to question if patients had an ACD or living will, and then cued residents to discuss these issues with the patients if they did not. Results Of the 77% of patients who were asked about ACDs, 74% had no ACD but were interested in discussing this topic. After our intervention, 65% (62 of 95) of our residents reported having at least 1 outpatient discussion with their patients. Residents reported increased confidence directing and discussing advanced care planning with older patients and conducting a family meeting (P < .01). Conclusions By delivering a formalized curriculum and creating a clinical environment that supports such discussions, resident physicians had more ACD discussions with their patients and reported increased confidence. When provided information and opportunity, patients consistently expressed interest in talking with their physician about their advanced care wishes.

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Timing of code status documentation and end-of-life outcomes in patients admitted to an oncology ward

Supportive Care in Cancer ◽

10.1007/s00520-013-1983-4 ◽

2013 ◽

Vol 22 (2) ◽

pp. 375-381 ◽

Cited By ~ 20

Author(s):

Amanda Caissie ◽

Nanor Kevork ◽

Breffni Hannon ◽

Lisa W. Le ◽

Camilla Zimmermann

Keyword(s):

End Of Life ◽

Life Outcomes ◽

Code Status ◽

Oncology Ward

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Development and Implementation of an End-of-Life Curriculum for Pediatric Residents

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909118786870 ◽

2018 ◽

Vol 35 (11) ◽

pp. 1439-1445 ◽

Cited By ~ 2

Author(s):

Paria M. Wilson ◽

Lori A. Herbst ◽

Javier Gonzalez-del-Rey

Keyword(s):

End Of Life ◽

Curriculum Design ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Pediatric Residents ◽

Resident Physicians ◽

Life Curriculum ◽

Stressful Experience ◽

Eol Care ◽

Dying Patient

Background: Caring for a child near the end of life (EOL) can be a stressful experience. Resident physicians are often the frontline providers responsible for managing symptoms, communicating difficult information, and pronouncing death, yet they often receive minimal education on EOL care. Objective: To develop and implement an EOL curriculum and to study its impact on resident comfort and attitudes surrounding EOL care. Design: Kern’s 6-step approach to curriculum development was used as a framework for curriculum design and implementation. Setting/Participants: Categorical and combined pediatric residents at a large quaternary care children’s hospital were exposed to the curriculum. Measurements: A cross-sectional survey was distributed pre- and postimplementation of the curriculum to evaluate its impact on resident comfort and attitudes surrounding EOL care. Results: One-hundred twenty-six (49%) of 258 residents completed the preimplementation survey, and 65 (32%) of 201 residents completed the postimplementation survey. Over 80% of residents reported caring for a dying patient, yet less than half the residents reported receiving prior education on EOL care. Following curriculum implementation, the percentage of residents dissatisfied with their EOL education fell from 36% to 14%, while the percentage of residents satisfied with their education increased from 14% to 29%. The postimplementation survey identified that resident comfort with communication-based topics improved, and they sought additional training in symptom management. Conclusions: The implementation of a longitudinal targeted multimodal EOL curriculum improved resident satisfaction with EOL education and highlighted the need for additional EOL education.

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