Longitudinal study of pediatric house officers' attitudes toward death and dying

Objective: To investigate pediatric residents' attitudes toward end-of-life issues and their education in dealing with these issues. Design:Exploratory survey. Setting: Department of Pediatrics at the University of California, Los Angeles, Center for Health Sciences. Subjects: Volunteer sample. A total of 182 of 203 pediatric residents at all levels of training completed anonymous questionnaires. Interventions: None. Measurements and Main Results: Data on residents' attitudes toward issues of death and dying and the efficacy of educational interventions were collected over a 4-yr period. When entering training, house officers are uncomfortable dealing with death and dying issues (mean, 3.3 of 5; 5 = not comfortable). By the end of their training, these house officers become comfortable dealing with these issues (mean, 2.2; p < .05). During their first 2 yrs of training, house officers report that their medical education is not helping them to deal with the issues of death and dying (mean, 3.3), At the end of their third year of training, residents report that their education is helping them to deal with these issues (mean, 2.5; p < .05). Strikingly, as house officers progress through their residency, they become less comfortable with the idea of administering pain medication to a dying patient, because the pain medication might hasten the patient's death (p < .05). Conclusions: Pediatric residents may benefit from more formal training in the practical aspects of death and dying issues. Residency education should do more to address these issues systematically far the benefit of both the residents and the patients and family members.