Changes in medical students' attitudes towards end-of-life decisions across different years of medical training

Psychological Factors Influencing Attitudes towards Euthanasia, Assisted Suicide and Palliative Care among Medical Students and Doctors in Training

Background: This study aimed to analyse the attitudes of medical students, Polish and classical philology students and trainee doctors towards the legalisation and practice of euthanasia and assisted suicide, to explore their beliefs about palliative care and to identify the cognitive, behavioural and emotional factors influencing these attitudes. Methods: An anonymous 22-question survey was sent by email to 670 participants, who comprised students of medicine, students of Polish and classical philology and trainee physicians. Results: Out of the 670 people invited to the survey, 313 (46.72%) responded; 215 (68.69%) and 112 (35.80%) participants supported the legalisation of euthanasia and assisted suicide, respectively. No differences were found between the respondent groups studied. The respondents' attitudes were influenced by religion, place of residence and professed values in the doctor-patient relationship. Among the medical students and trainee doctors surveyed, the declared willingness to perform euthanasia was lower, with 90 (43.7%) people, than the support for its legalisation, with 135 (65.5%) people. Significantly higher support for palliative care was expressed by fifth- and sixth-year medical students and trainee doctors, with 88 respondents (89.89%), less support was expressed by first- and fourth-year medical students, with 74 respondents (68.5%), and the lowest support was observed among Polish and classical philology students, with 63 respondents (58.9%). Conclusions: The legalisation of euthanasia and assisted suicide was supported by more than two-thirds and one-third of all the respondents, respectively, with the majority of medical students and trainee doctors surveyed expressing uncertainty or lack of readiness towards their practice. More than 70% of all the respondents showed a positive opinion towards palliative care, with the lowest support being among Polish and classical philology students.

Personality traits and attitude towards euthanasia among medical students in Serbia

OBJECTIVE

Various factors may influence the attitudes of medical students towards euthanasia, including personal values, beliefs, and personality traits. The objective of this study was to examine the attitudes of 2nd and 5th year medical students about euthanasia and the relationship between these attitudes and students' personality traits.

METHODS

Medical students from the Universities of Kragujevac and Belgrade, Serbia, participated in this study. A questionnaire was administered assessing attitudes toward euthanasia and student personality traits (honesty-humility, emotionality, extraversion, agreeableness, conscientiousness, and openness using the HEXACO-60).

RESULTS

More than 50% of students in the second year and 60% of students in the fifth year were supportive of euthanasia. Students in the 5th year were 2.5 times more likely to express a concern that euthanasia needs to be clearly regulated by law compared to students in the second year. Adjusted analyses indicated that lower levels of honesty-humility and emotionality were positively correlated with students' belief that euthanasia should be legalized.

CONCLUSION

Many medical students in Serbia have a positive attitude towards euthanasia. It is important to consider the possible influences of culture, religion, and the law on attitudes towards euthanasia. Undergraduate medical training should include more hours dedicated to palliative care and end-of-life topics to raise awareness of patients' preferences in this regard.

Medical students' and residents' views on euthanasia

BACKGROUND

Doctors are increasingly faced with end-of-life decisions. Little is known about how medical students approach euthanasia. The objective of this study was to evaluate, among medical students and residents, the view on euthanasia and its variants; correlate such a view with empathy and religiosity/spiritualism; and with the stages of medical training in Brazil.

METHODS

This is an exploratory cross-sectional study using an online questionnaire to be filled out on a voluntary basis among medical students and residents, consisting of: socio-demographic data, an empathy questionnaire and questions with elaborate clinical cases that typify situations of the variants of euthanasia.

RESULTS

From 1550 invitations, 273 volunteer participants responded (17.6%). The percentages of strong agreement/agreement on the concepts were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%). Passive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. Religious belief and degree of empathy did not significantly influence the opinion about the concepts. Strong agreement/agreement were: passive euthanasia (72.9%); active euthanasia (22.3%), orthothanasia (90.1%), dysthanasia (18.7%), assisted suicide (33%) and sedation (82.8%).

CONCLUSIONS

Passive euthanasia, active euthanasia, dysthanasia and assisted suicide showed greater refusal with increasing length of medical training. The external validation of our findings relies on the distinct legal, cultural, and religious frameworks found across various countries.

Knowledge and attitudes toward euthanasia among final year pharmacy and law students: a cross-sectional study

BACKGROUND

Euthanasia is the last resort for those living with untreatable and terminable diseases which cause pain and suffering. However, the concept of euthanasia resulted in many dilemmas and controversy around life extension and death.

OBJECTIVE

The aim of this study was to evaluate the knowledge and attitudes of final year pharmacy and law students concerning euthanasia.

METHODS

A descriptive cross-sectional study was carried out among all final year law and pharmacy undergraduate students. The data were collected using self-administered structured questionnaire and analyzed by SPSS version 22. Multivariate logistic regression was used to assess the influence of socio-demographic characteristics of participant's on acceptance of euthanasia.

RESULT

72 (61.5%) of the students were declared that euthanasia is administration of lethal drugs to a patient at the explicit request of that patient. Majority 87 (74.4%) of the students knew that euthanasia is active shortening of the dying process. Most participants 95(81.2%) awared that there is no legalized euthanasia in Ethiopia. On the other hand, 47(40.2%) believed the patient has the right to choose to end his/her own life. Around 45% had the view that euthanasia should be legalized in some circumstances. Only 27.3% (n = 32) of the respondents endorsed legalization of euthanasia in Ethiopia. 35 (29.9%) said euthanasia should be performed. The acceptance of euthanasia was greater for pharmacy students compared to law students [adjusted odds ratio (AOR) = 3.490; 95% CI 1.346-9.049; p = 0.010] and lower for Muslim students compared to Orthodox students (AOR = 0.186; 95% CI 0.044-0.783; p = 0.022).

CONCLUSION

The final year law and pharmacy students were aware of euthanasia. However, majority of students did not reveal favorable attitude toward euthanasia and its acceptance was low. Participants' field of study and religion were significantly affect acceptance of euthanasia As the current study limited to pharmacy and law students, the authors suggest that future studies should involve various segments of societies to investigate more about euthanasia in Ethiopia.

Assessing Medical Students' Confidence towards Provision of Palliative Care: A Cross-Sectional Study

Under a surging demand for palliative care, medical students generally still show a lack of confidence in the provision in abroad studies. This cross-sectional study aims to investigate the confidence and its association with knowledge, attitude and exposure on providing palliative care among medical undergraduates with a self-administered questionnaire to improve the international phenomenon. Full-time local medical undergraduates were recruited to obtain information regarding the demographics, confidence, knowledge, attitude and exposure on palliative care; the information was collected from July 2020 to October 2020. Questions on confidence (10-items), knowledge (20-items), attitude (10-items) and exposure were referenced from validated indexes and designed from literature review. Confidence level was categorized into “Confident” and “Non-confident” as suggested by studies to facilitate data analysis and comparison. Of the 303 participants, 59.4% were “Non-confident” (95% C.I.: 53.8% to 65.0%) in providing palliative care on average. Among medical students, knowledge (p = 0.010) and attitude (p = 0.003) are significantly positively associated with the confidence to provide palliative care, while exposure to death of family/friends (p = 0.024) is negatively associated. This study begins an investigation on the research area in Hong Kong primarily. The confidence of local medical students should be enhanced to provide palliative care in their future. It thus highlights the importance of the medical curriculum and provides insights to remove barriers responsively to improve the overall confidence and the quality of palliative care.

Medical Faculty Students' Views on Euthanasia: Does It Change With Medical Education?

OBJECTIVE

Euthanasia is the decision to terminate the lives of patients who do not improve with medical treatment at their explicit request. This study was carried out to determine the opinions of medical students regarding euthanasia and to evaluate the effect of medical education on this issue.

METHODS

This cross-sectional study was conducted among first and sixth-year students of the Gaziantep University School of Medicine during the 2018-2019 academic years.

RESULTS

Of the 242 students who participated in the study, 54.1% (131) were first-year and 45.9% (111) were sixth-year students. Overall, 39.7% of the first-year students and 31.5% of the sixth-year students supported active euthanasia. The percentage of students who were against passive euthanasia and physician-assisted suicide (PAS) was 63.4% and 53.4% for first-year students and 49.5% and 54.1% for sixth-year students, respectively.

CONCLUSION

Approximately half of the first and the sixth-year students were opposed to active euthanasia, passive euthanasia, and PAS, and there was no significant difference between these two groups of students in their being against euthanasia. However, there were significant differences between these two groups with respect to their reasons against euthanasia.

New Zealand medical students' views of euthanasia/assisted dying across different year levels

BACKGROUND

Previous studies report a majority of the general public support euthanasia/assisted dying (EAD), while a majority of doctors are opposed. In considering policy decisions about EAD, some may discount the views of doctors because they take them to be based on personal values or tradition, rather than reasons that the general public might share. One way to explore this notion is to examine whether medical students' views change during their medical education. The objective of this study was to learn how New Zealand medical students view EAD and whether students at different year levels have different views.

METHODS

An on-line survey of undergraduate medical students was conducted asking whether they supported a law change to allow EAD. Quantitative data was analysed using unadjusted and multiple logistic regression. Thematic analysis was conducted with the qualitative data.

RESULTS

A total of 326 students replied to the survey. The overall response rate was 28%. 65% of 2nd year students were supportive of EAD, compared to 39% in 5th year. The odds of 5th year students supporting a law change compared to 2nd year was 0.30 (95% CI: 0.15-0.60). The predominant themes found in the qualitative results indicate that medical students support or oppose EAD for reasons similar to those found in the wider debate, and that their views are influenced by a range of factors. However, several at all year levels cited an aspect of medical school as having influenced their views. This was mentioned by participants who were supportive of, opposed to, or unsure about EAD, but it was the type of influence most often mentioned by those who were opposed.

CONCLUSIONS

The quantitative findings show students at the end of 5th year were less likely to support EAD than students at the end of 2nd year. We suggest that this difference is most likely due to their time in medical education. This suggests that the lower support found among doctors is in part related to medical education and medical work rather than age, personality, or social context. The qualitative findings indicate that this is not related to a particular educational experience at Otago Medical School but a range.

Status of palliative care education in Mainland China: A systematic review

OBJECTIVE

China is home to one-fifth of the world's population. In the setting of a growing and aging population as well as the designation of palliative care access as a human right in 2013, the implementation of palliative care in China gains special importance. Palliative care education is an important precondition to ensure a nationwide access to palliative care. This systematic review details the status of under- and postgraduate palliative care education in China, examining both the students' and physicians' perception, knowledge, and skills in palliative care, and the available educational interventions and programs.

METHOD

Four databases were searched in September 2018, using considered search terms. Titles, abstracts, and, if necessary, full texts were scanned to identify publications matching the inclusion criteria.

RESULTS

Nine publications were included. They revealed six findings: palliative care education is lacking in both under- and postgraduate medical education, only a few programs exist. Palliative care as a concept is well known, detailed knowledge, and practical skills are less developed. Chinese physicians consider palliative care an important field to be developed in cancer care, yet the majority of healthcare professionals are not willing to work in palliative care services. Communication should be a main emphasis in palliative care education, especially in undergraduate training. Finally, there is no highly qualified research on under- or postgraduate palliative care education in Mainland China.

SIGNIFICANCE OF RESULTS

These findings suggest that palliative care education in China is in demand and should be systematically integrated into medical education. Further research on the topic is urgently needed.

Medical Assistance in Dying: the opinions of medical trainees in Newfoundland and Labrador. A cross- sectional study

BACKGROUND

Medical Assistance in Dying (MAiD) was legalized in Canada in 2016. As future physicians, medical trainees may face decisions regarding MAiD. Although many publications exist internationally, Canadian data is limited in the peer-reviewed literature, particularly following legalization. The purpose of this study is to determine the opinions of medical trainees in Newfoundland and Labrador regarding MAiD, and the factors that impact these views.

METHODS

A survey was distributed to all under- and postgraduate medical trainees at Memorial University (N=570), the only medical school in Newfoundland and Labrador. The survey collected demographic information and opinions regarding MAiD. Respondents were divided into groups based on demographic characteristics, and their responses analyzed using non-parametric statistics.

RESULTS

The survey was completed by 124 trainees. Ninety percent of respondents agreed with the legalization of MAiD in Canada and nearly 60% stated they would perform the procedure for their patients. Several factors influenced the opinions of medical trainees, including level of training and religious affiliation. Trainees also favored detachment from the MAiD process.

INTERPRETATION

Medical trainees in Newfoundland and Labrador are largely in favor of MAiD. This may highlight the importance of emphasizing MAiD within medical curricula, so that trainees are adequately informed and prepared for this new aspect of medical care upon joining independent practice.

Attitude Towards End of Life Communication of Austrian Medical Students

Medical students have to acquire theoretical knowledge, practical skills, and a personal attitude to meet the emerging needs of palliative care. The present study aimed to assess the personal attitude of Austrian medical students towards end of life communication (EOLC), as key part of palliative care. This cross-sectional, mono-institutional assessment invited all medical students at the Medical University of Vienna in 2015. The assessment was conducted web-based via questionnaire about attitudes towards EOLC. Additional socio-demographic and medical education-related parameters were collected. Overall, 743 medical students participated in the present report. Differences regarding the agreement or disagreement to several statements concerning the satisfaction of working with chronically ill patients, palliative care, and health care costs, as well as the extent of information about palliative disease, were found for age, gender, and academic years. The overall attitude towards EOLC in the present sample can be regarded as quite balanced. Nevertheless, a considerable number of medical students are still reluctant to inform patients about their incurable disease. Reservations towards palliative care as part of the health care system seem to exist. The influence of the curriculum as well as practical experiences seems to be important but needs further investigation.

Attitude of nurses towards euthanasia: a cross-sectional study in Iran

Background:

Nurses play a major role in providing end-of-life care, and euthanasia is considered to be one of the most important ethical challenges that care providers can face.

Aim:

To assess the nurses' attitude towards euthanasia in Iran.

Methods:

The cross-sectional study included nurses who worked in intensive and critical care, as well as dialysis units of a teaching hospital affiliated to Zahedan University of Medical Sciences, who were selected by the census sampling technique. Data were collected using a two-part questionnaire encompassing the demographic characteristics of nurses and the 20-item Euthanasia Attitude Scale.

Results:

The overall score of nurses' attitudes towards euthanasia, ranging from one to five, was 2.71±0.45, indicating a negative attitude and opposition towards euthanasia. Alongside this, the results demonstrated that there was no significant relationship between demographic characteristics and nurses' attitudes toward euthanasia.

Conclusion:

In general, nurses in Iran oppose euthanasia. This can be attributed to the context of religious beliefs and culture in Iran as an Islamic country.

Withholding Treatment From the Dying Patient: The Influence of Medical School on Students' Attitudes

PURPOSE

To determine motives and attitudes towards life-sustaining treatments (LSTs) by clinical and preclinical medical students.

METHODS

This was a scenario-based questionnaire that presented patients with a limited life expectancy. The survey was distributed among 455 medical students in preclinical and clinical years. Students were asked to rate their willingness to perform LSTs and rank the motives for doing so. The effect of medical education was then investigated after adjustment for age, gender, religion, religiosity, country of origin, and marital status.

RESULTS

Preclinical students had a significantly higher willingness to perform LSTs in all cases. This was observed in all treatments offered in cases of a metastatic oncologic patient and an otherwise healthy man after a traumatic brain injury (TBI). In the case of an elderly woman on long-term care, preclinical students had higher willingness to supply vasopressors but not perform an intubation, feed with a nasogastric tube, or treat with a continuous positive air-pressure ventilator. Both preclinical and clinical students had high willingness to perform resuscitation on a twelve-year-old boy with a TBI. Differences in motivation factors were also seen.

DISCUSSION

Preclinical students had a greater willingness to treat compared to clinical students in all cases and with most medical treatments offered. This is attributed mainly to changes along the medical curriculum. Changes in reasons for supplying LSTs were also documented.

Changes in ethical attitudes of clinical laboratory professionals after teaching them ethics using three different methods

Background: Ethical attitudes and personal values play a significant role in clinical decision-making; however, they have been given limited attention by professionals in laboratory medicine. Studies suggest that individual attitudes are not static and that professionals learn ethical attitudes through a variety of formal and informal learning methods. This study was conducted to investigate changes in the attitudes of clinical laboratory professionals after teaching them ethics and to compare the results among the 3 groups. Methods: Four topics were selected in the field of medical laboratory ethics as teaching materials. A questionnaire including 22 items was designed and validated. Teaching sessions for the 3 study groups were held. All 65 clinical laboratory participants completed the questionnaire before and after the classes. Paired t test and ANOVA were used to assess differences among groups. Results: Significant differences were found in the mean scores of ethical attitudes before and after the educational intervention among the lecture-based teaching group (p=0.016), problem-based learning group (p=0.001), and all participants (p=0.004). However, no significant difference was found between the mean scores before and after the intervention in role-playing group (p=0.623). Conclusion: Teaching by lecturing and problem-based learning was more effective to change ethical attitude of the laboratory professionals than the role-playing method. Thus, we suggest the implementation of teaching ethics using these methods to improve the ethical attitude of clinical laboratory professionals.

Medical students and end-of-life decisions: the influence of religion

The objective of this study was to see if medical students' attitudes about medically assisted dying were influenced by their religious background and current beliefs. A cohort study was conducted using a self-completion study questionnaire in a large UK medical school. In total, 400 out of 505 questionnaires were completed (79%). The study population's characteristics are summarised as follows: mean age 22.7 years (range 18-44); 68.5% believe in god, 31.5% have no belief in god; religious background: Christian 45%, Hindu 16.5%, Muslim 22%, Other 10% and None 7%. The majority of students did not agree with euthanasia and physician-assisted suicide in the study scenario. Those who had a belief in god were more likely to disagree with actions that hasten death. The findings show this was particularly the case with students from a Muslim background. Gender was not related to overall agreement with actions that hasten death; being older, a finalist and a graduate were weakly associated with a greater likelihood of agreeing with such acts. This is an important issue which warrants further enquiry. The demographics of the UK medical population continue to shift, containing a higher proportion of people from Asia and with Asian British backgrounds than the general population. This study provides us with a basis for further exploration of the potential for disparity between the opinions of the UK population and those of medical workers and trainees, and how that might inform decisions about patient care at the end of life.

Attitudes Toward Euthanasia Among Turkish University Students

This study aims to examine perceptions and attitudes toward euthanasia among university students who are pursuing bachelor’s degrees. Although the legalization and application of euthanasia are discussed commonly by health-care professionals and partially by lawyers, the ideas of other segments of society, especially university students, are taken place very rarely. The research was conducted descriptively to determine the ideas of 1,170 students at Kastamonu University from six different departments: arts and sciences, theology, tourism, nursing, school of physical education, and sports with using a questionnaire. Findings demonstrated that 73.2% of the students do not approve euthanasia. Also, it was found that there are significant differences depending on age, gender, department of study, income level, place of living, and the loss of kinsmen. This study serves as a resource for future research to understand the effects of sociodemographic characteristics on the decision of euthanasia.

Euthanasia: A Controversial Entity Among Students of Karachi

Background A serene death may be achieved through skilled and compassionate care, as well as by the dying person's own sense of having lived a righteous life. The purpose of this study is to acquire information about students' knowledge and understanding of euthanasia. Materials and Methods Four hundred and fifty-six students from four classes of two institutions with similar demographic characteristics were included in this cross-sectional study. A questionnaire adapted from a study of 'Gruber, et al.' was distributed among the respondents after obtaining a verbal informed consent. The questionnaire had two parts, first dealing with demographics of respondents, and in the second part students were given different situations and asked about their decision in that particular setting to understand their opinion about euthanasia. Results There were 31.7% medical students and 12.9% non-medical students in favor to provide complete medical information (p < 0.001) while 59.2% non-medical students thought that complete information should be given to a patient if any iatrogenic incident occurred. Same favored by 33.7% of medical students (p < 0.001). The majority of medical students (84.5%) felt that cardiopulmonary resuscitation (CPR) must always be provided (p < 0.001) and this was acceptable more among females (p = 0.001). Furthermore, medical students (57.6%) were more in favor of continuing maximum medical treatment including CPR than non-medical students (42.9%, p = 0.003). A total of 83% non-medical students and 46% medical students found euthanasia an acceptable practice. Conclusion Results show a significant difference in perception of medical and non-medical students regarding euthanasia. Non-medical students are more in favor of euthanasia than medical students. Also, it is observed that males seem to be more inclined towards euthanasia while females are more in favor to provide maximum medical treatment.

Establishment of medical education upon internalization of virtue ethics: bridging the gap between theory and practice

During medical training, students obtain enough skills and knowledge. However, medical ethics accomplishes its goals when, together with training medical courses, it guides students behavior towards morality so that ethics-oriented medical practice is internalized. Medical ethics is a branch of applied ethics which tries to introduce ethics into physicians' practice and ethical decisions; thus, it necessitates the behavior to be ethical. Therefore, when students are being trained, they need to be supplied with those guidelines which turn ethical instructions into practice to the extent possible. The current text discusses the narrowing of the gap between ethical theory and practice, especially in the field of medical education. The current study was composed using analytical review procedures. Thus, classical ethics philosophy, psychology books, and related articles were used to select the relevant pieces of information about internalizing behavior and medical education. The aim of the present study was to propose a theory by analyzing the related articles and books. The attempt to fill the gap between medical theory and practice using external factors such as law has been faced with a great deal of limitations. Accordingly, the present article tries to investigate how and why medical training must take internalizing ethical instructions into consideration, and indicate the importance of influential internal factors. Virtue-centered education, education of moral emotions, changing and strengthening of attitudes through education, and the wise use of administrative regulations can be an effective way of teaching ethical practice in medicine.

Medical Students' Professionalism Narratives Reveal That Experiences With Death, Dying, or Palliative Care Are More Positive Than Other Experiences During Their Internal Medicine Clerkship

PURPOSE

More physicians need to acquire the skills of primary palliative care. Medical students' clerkship experiences with death, dying, and palliative care (DDPC), however, may create barriers to learning such skills during residency. Whether professional development is differentially affected by DDPC is unknown. This knowledge gap potentially hinders the development of educational strategies to optimize students' preparedness for primary palliative care.

METHOD

Third-year students submitted professionalism narratives (N = 4062) during their internal medicine clerkship between 2004 and 2011. We identified DDPC-related narratives and then randomly selected control narratives. Narratives were compared by valence (positive or negative) and professionalism-related themes.

RESULTS AND CONCLUSION

Less than 10% of the narratives were related to DDPC, but the majority was positive. There was a significant overlap in professionalism themes between DDPC and control narratives. The results suggest student preparedness for primary palliative care may be improved by addressing the common professionalism challenges of clinical clerkships.

An important but stressful part of their future work: medical students' attitudes to palliative care throughout their course

CONTEXT

Palliative care (PC) education for medical students is important. Knowledge concerning drugs and services can be readily taught, and skills of communicating with terminally ill patients and their families are increasingly being addressed. Developing positive attitudes toward caring for patients near the end of life is more challenging.

OBJECTIVES

To examine medical students' attitudes toward PC in each year of their course, investigate changes in these attitudes over time during their course, and identify gender differences in attitudes and attitudinal change.

METHODS

Questionnaires administered to four cohorts of preclinical core science and clinical medical students at the University of Cambridge Medical School from 2007 to 2010, with annual longitudinal follow-up in subsequent years; 1027 participants in total.

RESULTS

Students started their medical course with broadly positive attitudes toward PC, which largely persisted into the final years. During the core science component, some attitudes became more negative, whereas during the clinical component, some attitudes became more positive. Over the whole course, there was evidence of increasingly positive attitudes. No significant effect of gender on attitudes or attitudinal change was found. Although statistically significant, all these changes were small.

CONCLUSION

Medical students' attitudes toward their future role in caring for people with PC needs were broadly positive. Core science was associated with increasingly negative attitudes and clinical studies with increasingly positive attitudes. For teaching faculty, the challenge remains to address negative and foster positive attitudes toward PC during medical school.

Changes in the Attitude and Practice Toward End-of-Life Care: Perspective of Chinese Physicians in Medical Department

INTRODUCTION

End-of-life care is affected by the attitude and cultural influence of doctors.

METHODS

To investigate the attitudes and practices of doctors on end-of-life care by questionnaire survey in 2004 and 2008.

RESULTS

In 2004, 31.7% of the respondents agreed that they "do not attempt resuscitation" (DNAR) form was useful and it rose to 54.4% in 2008. A higher proportion of respondents in 2008 claimed that they signed the DNAR form for documentation and accepted withholding noninvasive life-sustaining treatment compared to 2004. In 2004, 50% of the respondents regarded their training and education on handling DNAR issue as inadequate.

CONCLUSION

Documentation by DNAR form is gaining wider acceptance. Many doctors are expected to have more training and coaching on communication for handling such sensitive issues.

The impact of pediatric palliative care education on medical students' knowledge and attitudes

Purpose. Most undergraduate palliative care curricula omit pediatric palliative care (PPC) issues. Aim of the study was to evaluate the pilot education programme. Methods. All 391 students of Faculty of Medicine (FM) and 59 students of Division of Nursing (DN) were included in anonymous questionnaire study. Respondents were tested on their knowledge and attitude towards PPC issues before and at the end of the programme and were expected to evaluate the programme at the end. Results. For final analysis, authors qualified 375 double forms filled in correctly (320 FM and 55 DN). Before the programme, students' knowledge assessed on 0–100-point scale was low (FM: median: 43.35 points; 25%–75%: (40p–53.3p); DN: 26.7p; 13.3p–46.7p), and, in addition, there were differences (P < 0.001) between both faculties. Upon completion of the programme, significant increase of the level of knowledge in both faculties was noted (FM: 80p; 73.3–100; DN: 80p; 66.7p–80p). Participation in the programme changed declared attitudes towards some aspects of withholding of special procedures, euthanasia, and abortion. Both groups of students positively evaluated the programme. Conclusions. This study identifies medical students' limited knowledge of PPC. Educational intervention changes students' attitudes to the specific end-of-life issues. There is a need for palliative care curricula evaluation.

A comparison of attitudes toward euthanasia among medical students at two Polish universities

The aim of the study conducted upon completion of obligatory palliative medicine courses among 588 medical students at two universities was to compare their attitudes toward euthanasia. Four hundred ninety-two (84.97 %) students were Catholics; 69 (11.73 %) declared they would practice euthanasia, 303 (51.53 %) would not, and 216 students (36.73 %) were not sure. The idea of euthanasia legalisation was supported by 174 (29.59 %) respondents, opposed by 277 (47.11 %), and 137 (23.30 %) were undecided. Five hundred fifty-six (94.56 %) students did not change their attitudes toward euthanasia after palliative medicine courses. Students from the two universities were found to have different opinions on practicing euthanasia, euthanasia law and possible abuse which might follow euthanasia legalisation, but they shared similar views on the choice of euthanasia if they themselves were incurably ill and the legalisation of euthanasia. Gender and religion influenced students' answers. Differences observed between medical students at the two universities might be related to gender and cultural differences.

Perspectives of physicians and nurses regarding end-of-life care in the intensive care unit

CONTEXT

The delivery of end-of-life care (EOLC) in the intensive care unit (ICU) varies widely among medical care providers. The differing opinions of nurses and physicians regarding EOLC may help identify areas of improvement.

OBJECTIVE

To explore the differences of physicians and nurses on EOLC in the ICU and how these differences vary according to self-reported proficiency level and primary work unit.

DESIGN

Cross-sectional survey of 69 ICU physicians and 629 ICU nurses.

SETTING

Single tertiary care academic medical institution.

RESULTS

A total of 50 physicians (72%) and 331 nurses (53%) participated in the survey. Significant differences between physicians and nurses were noted in the following areas: ability to safely raise concerns, do not resuscitate (DNR) decision making, discussion of health care directives, timely hospice referral, spiritual assessment documentation, utilization of social services, and the availability of EOLC education. In every domain of EOLC, physicians reported a more positive perception than nurses. Additional differences were noted among physicians based on experience, as well as among nurses based on their primary work unit and self-reported proficiency level.

CONCLUSIONS

Even with an increased focus on improving EOLC, significant differences continue to exist between the perspectives of nurses and physicians, as well as physicians among themselves and nurses among themselves. These differences may represent significant barriers toward providing comprehensive, consistent, and coordinated EOLC in the ICU.