Analysis of the Nurses' and Physicians' Opinion Regarding Their End-of-Life Education

Dear Editor:

The review of literature proves that preparation of physicians and nurses for end-of-life care is still not adequate and needs to be improved.^1–9 One useful method to develop end-of-life education is analysis of the experience of physicians and nurses in their care for the dying. This should be the one basis for updating curricula in the domain.

We analyzed nurses' (n = 124) and physicians' (n = 98) self-evaluation of their end-of-life education. Our respondents were working in general hospitals in the south-east part of Poland and had frequent contact with dying patients (51%).

Nearly half the nurses said that their professional training had prepared them sufficiently for end-of-life care (49%). Physicians were of the opposite opinion (44%). 36% of physicians do not remember if such content had appeared during their education.

Undergraduate education of both doctors and nurses predominantly prepared them for taking care of the biological sphere of the dying (95% of nurses and physicians); and caring for the patient's psychological sphere (76% of nurses and 53% of physicians). Presence of these issues in education programmes is confirmed also in the study of Dickinson et al. ² and Field and Wee ¹⁰ concerning end-of-life education programs in U.K. medical schools.

However, our respondents mentioned lack of education regarding communication and collaboration with the dying patient's family and emotional support of the family members (52% of nurses and 63% of physicians); and dealing with own emotions facing someone's death (62% of nurses and 63% of physicians). These topics were also cited as those of most interest in potential postgraduate end-of-life education, in which 69% of respondents would like to take part. The U.S. study ¹¹ shows that nearly half of the respondents rated ability of health care workers to provide emotional support for dying patients and family members as fair or poor. The study of White et al. ¹² on the issue of “how to talk to the patient's family about dying” is the leading issue among core competencies that nurses wish they had learned in nursing school. Both the study of Dickinson et al. ² as well as Field and Wee ¹⁰ confirm that education programs that were analyzed included the subject concerning attitudes towards death and dying, considering the topic of copying with emotions in the face of death. The need of completion of this issue in medical education and achievement of the skill of coping with emotions when a patient is dying is underlined by Thompson ⁷ and White et al. ¹²

Over 50% of the respondents maintain that looking after a patient at the end-of-life is difficult and more than a half of them (54%) would not be able to take a job in any palliative institution (46% of nurses, 63% of physicians).

Medicine still treats death as a defeat instead of treating it as a part of life. Professional education should change priorities of what they teach about medical care for the dying and demonstrate how much clinicians can do to improve a patient's end-of-life experience. ¹³ When building curricula, it is important to consider nurses' and physicians' opinions because they know what knowledge and skills they really need to care for the dying.