Doctors in the United States frequently face situations involving death and dying, but a new study from Washington State University (WSU) suggests that medical students receive little formal education on how to guide patients and families through end-of-life care.
The research team reviewed 43 published articles dating back to 2013 on how U.S. medical schools teach about death and dying. The review found significant variation in educational approaches, with limited evidence-based instruction on working with patients and their families during end-of-life situations. The findings were published in Academic Medicine.
Logan Patterson, who recently graduated from WSU's Elson S. Floyd College of Medicine and is the lead author of the paper, noted the importance of this training for physicians, especially those treating cancer patients. "Doctors need to be comfortable with the topic of death and talking to patients about it, especially those with cancer," said Patterson. "Training for those conversations isn't really taught in medical institutions. A lot of that has to do with required medical testing; multiple choice questions about care planning are hard to write because of the detail required."
Most studies included in the review used low-rigor designs and short interventions focused on providing information or integrating new skills rather than comprehensive education. As a result, researchers recommend implementing evidence-based interventions throughout the medical school curriculum regardless of specialty.
Patterson pointed out that while medical schools recognize these gaps, finding space in an already crowded curriculum remains a challenge. He hopes this research will encourage institutions to prioritize end-of-life care education. "The first step in figuring out how to teach it is to see how it's currently being taught," he said. "We found that it really isn't being taught at all."
During his own training, Patterson observed firsthand the consequences of insufficient preparation: "If you do one shift in an emergency room, you'll likely see a patient who hasn't grappled with end-of-life questions," he said. "Several times I saw families bring a patient with a chronic condition to the hospital because they thought that's what the person wanted, only to learn they didn't want to be there. Better training for doctors could head off the confusion before it becomes a time-sensitive condition in the hospital."
Weaver, another researcher specializing in gerontological issues including death and dying, added that more robust training could reduce unnecessary costs and unwanted treatments at life's end: "Research shows that health care is most expensive in the last year of life, and a lot of that is unwanted treatment," she said. "Physicians, understandably, want to save lives. But they often don't consider quality of life."
Patterson emphasized his goal is ultimately patient-centered: "I think almost any doctor will tell you there's a lack of death and dying training," he said. "It's inevitable that doctors will talk about this with patients. Any boost of knowledge early in their careers will only help them and those they care for."
