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

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A Capsule Commentary to this article was published on 23 April 2014

ABSTRACT

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.

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ACKNOWLEDGMENTS

We thank Pete Charpentier and Katy Araujo for their capable assistance with data entry and analysis. The research reported in this manuscript was supported by the James G. Hirsch, MD, Endowed Medical Student Research Fellowship. This sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.

Conflicts of interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, Yale University School of Medicine, 337 Crown Street, New Haven, CT, 06511, USA

    John M. Thomas MD & Terri R. Fried MD

  2. Center of Excellence in Primary Care Education, VA Connecticut Healthcare System, West Haven, CT, USA

    John M. Thomas MD

  3. Program on Aging, Yale University School of Medicine, New Haven, CT, USA

    John R. O’Leary MA & Terri R. Fried MD

  4. Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, CT, USA

    Terri R. Fried MD

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  1. John M. Thomas MD
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  3. Terri R. Fried MD
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Correspondence to John M. Thomas MD.

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Thomas, J.M., O’Leary, J.R. & Fried, T.R. 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 29, 1048–1054 (2014). https://doi.org/10.1007/s11606-014-2830-0

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