A Comparison of the Willingness of Resident and Attending Physicians to Comply with the Requests of Patients at the End of Life.

Journal of General Internal Medicine

PubMedID: 24647724

O'Leary JR, Fried TR, Thomas JM. A Comparison of the Willingness of Resident and Attending Physicians to Comply with the Requests of Patients at the End of Life. J Gen Intern Med. 2014;29(7):1048-54.
BACKGROUND
Little is known about the differences between physicians in training and post training in their willingness to comply with patient requests at the end of life.

OBJECTIVE
To compare the attitudes of attendings and residents regarding a range of patient requests at the end of life DESIGN: Written, cross-sectional survey PARTICIPANTS: The cohort included 191 attendings randomly selected across the state of Connecticut and 240 residents from 2 university-affiliated Internal Medicine programs.

MAIN MEASURES
We surveyed attendings and residents about their willingness to honor the requests of the same decisionally capable elderly patient in five scenarios involving different requests regarding end-of-life treatment.

RESULTS
While a large majority of both attendings and residents were willing to comply with each of the requests to withhold intubation (100 % and 94 %, respectively), to extubate (92 % and 77 %), and to give increasingly higher doses of narcotics (94 % and 71 %), a significantly larger proportion of attendings versus residents was willing to comply with each of these requests. Small proportions of attendings and residents were willing to prescribe a lethal amount of sleeping pills (3 % and 5 %, respectively) and to give a lethal injection in its current illegal state (1 % and 4 %). A significantly larger proportion of residents (32 %) compared to attendings (19 %) was willing to give a lethal injection if legal. Adjusting for sociodemographic factors, attending status was independently associated with willingness to extubate [adjusted odds ratio (AOR)?=?3.0, 95 % CI?=?1.6-5.7] and to give a lethal injection if legal (AOR?=?0.5, 95 % CI?=?0.3-0.8). The proportion of physicians willing to extubate increased across years since graduation, with the greatest differences occurring across the residency years (69 % to 86 %).

CONCLUSIONS AND RELEVANCE
Clinical experience was an important determinant of physicians' willingness to perform multiple patient requests at the end of life, with substantial changes in attitudes occurring during residency training. More research is needed to determine whether dedicated clinical exposure for physicians in training influences attitudes.