Do Doctors Gain More Confidence from a Longer Palliative Medicine Posting?

BACKGROUND: Doctors report inadequate training and lack confidence in providing palliative care. Although palliative care training improves self-assessed competence, it is not known whether the duration of a palliative medicine (PM) posting affects the extent of improvement in confidence. OBJECTIVE: The aim of this study was to determine whether the duration of a PM posting affects the extent of improvement in doctors' confidence in various aspects of palliative care. METHODS: This was a retrospective study analyzing doctors' self-rated competence level in different aspects of palliative care at the start and end of a PM posting. The change in scores was analyzed to determine the extent of improvement corresponding to the length of the posting. Seventy-one residents and medical officers participated in the study, which was conducted in a hospital-based palliative care consultative service. RESULTS: Participants reported low baseline self-rated competence in palliative care. A longer posting duration resulted in a greater improvement in the doctors' confidence across different domains of palliative care, particularly in end-of-life communication. CONCLUSION: A one-month posting may suffice in training a doctor in basic end-of-life medical issues, but a longer posting duration results in a greater improvement in the doctors' confidence across different domains of palliative care, particularly in end-of-life communication. Trainee doctors in specialties that frequently deal with terminally ill patients should undertake a longer posting in PM to be further equipped with greater confidence to better care for these patients.

Distancing sedation in end-of-life care from physician-assisted suicide and euthanasia.

Lipuma equates continuous sedation until death (CSD) to physician-assisted suicide/euthanasia (PAS/E) based on the premise that iatrogenic unconsciousness negates social function and, thus, personhood, leaving a patient effectively 'dead'. Others have extrapolated upon this position further, to suggest that any use of sedation and/or opioids at the end of life would be analogous to CSD and thus tantamount to PAS/E. These posits sit diametrically opposite to standard end-of-life care practices. This paper will refute Lipuma's position and the posits borne from it. We first show that prevailing end-of-life care guidelines require proportional and monitored use of sedatives and/or opioids to attenuate fears that the use of such treatment could hasten death. These guidelines also classify CSD as a last resort treatment, employed only when symptoms prove intractable, and not amenable to all standard treatment options. Furthermore, CSD is applied only when deemed appropriate by a multidisciplinary palliative medicine team. We also show that empirical data based on local views of personhood will discount concerns that iatrogenic unconsciousness is tantamount to a loss of personhood and death.