Several initiatives to improve care at the end of life involve educational programs to influence clinicians’ attitudes about care for patients with terminal illnesses. The objective of this research was to develop and test a short and easily administered instrument for measuring physicians’ and nurses’ attitudes towards care at the end of life. The instrument was tested using a cross-sectional study of 50 clinicians (25 physicians and 25 nurses) from general medicine, cardiology, oncology, and geriatric medicine. Both reliability and validity were assessed, and the instrument was found to have acceptable test-retest reliability and construct validity. Such an assessment instrument may be useful in evaluating the impact of initiatives to modify attitudes towards terminal care and in improving the quality of care at the end of life.
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References
1.
HansonLC, DanisM, GarrettJ.What is wrong with end-of-life care? Opinions of bereaved family members. J Am Geriatr Soc1997; 45: 1339–1344.
2.
Council on Scientific Affairs, American Medical Association. Good care of the dying patient. JAMA1996; 275: 474–478.
EmanuelEJ and EmanuelLL. The promise of a good death. Lancet1998; 351: 21–27.
5.
BachmanJG, AlcserKH, DoukasDJ, LichtensteinRL, ComingAD, BroadyH.Attitudes of Michigan physicians and the public towards legalizing physician-assisted suicide and voluntary euthanasia. N Engl J Med1996; 334: 303–309.
6.
ByockIR. Final Exit: a wake up call to hospice. Hospice Journal1991; 7: 51–66.
7.
SUPPORT Principal Investigators. A controlled trial to improve care for seriously ill hospitalized patients. JAMA1995; 274 (20):1591–1598.
8.
LynnJ, TenoJM, PhillipsRS, . Perceptions of family members of the dying experience of older and seriously ill patients. Ann Intern Med1997; 126: 97–106.
9.
PortenoyRK, ThalerHT, KornblithAB, . Symptom prevalence, characteristics, and distress in a cancer population. Qual Life Res1994; 3: 183–189.
10.
Catalan-FernandezJG, Pons-SuredaO, Recober-MartinezA, Avella-MestreA, Carbonero-MalbertiJM, Benito-OliverE.Dying of cancer: the place of death and family circumstances. Med Care1991; 29 (9):841–852.
11.
BernabeiR, GambassiG, LaPaneK, . Management of pain in elderly patients with cancer. JAMA1998; 279 (23):1877–1882.
12.
AllebeckP, BolundC, RingbackG.Increased suicide rate in cancer patients: a cohort study based on the Swedish cancer registry. J Clin Epidemiol1989; 42: 611–616.
13.
BradleyEH, PeirisV, WetleT.Discussions of end-of-life care in nursing homes.J Amer Geriatr Soc (in press).
14.
ReillyB, MagnussenR, RossJ, . Can we talk? Inpatient discussions about advance directive in a community hospital. Arch Intern Med1994; 154: 2299–2308.
15.
HofmannJC, WengerNS, DavisRB, TenoJ, ConnorsAF, DesbiensN, LynnJ, Phillips RS for SUPPORT Investigators. Patient preferences for communication with physicians about end of life care. Ann of Intern Med 1997; 127 (11):1–12.
16.
WetleT, LevkoffS, CwikelJ, RosenA.Nursing home resident participation in medical decisions: perceptions and preferences. Gerontologist1988; 28: 12–38.
17.
LurieN, PheleyA, MilesS, . Attitudes towards discussion life-sustaining treatments in extended care facility patients. J Am Geriatr Soc1992; 40: 1205–1208.
18.
SolomonM, O'DonnellL, JenningsB, . Discussions near the end of life: professional views on life-sustaining treatments. Am J Pub Health1993; 83: 14–23.
19.
HansonLC, TulskyJA, DanisM.Can clinical interventions change care at the end of life?Ann Intern Med1997; 126: 381–388.
20.
OngLML, DeHaesJC, HoosAM, LammesFB. Doctor-patient communication: a review of the literature. Soc Sci Med1995; 40 (7):903–918.
21.
KaplanSH, GreenfieldS, and WareJE. Assessing the effects of clinician-patient interactions on the outcomes of chronic disease. Med Care27(3): S110–127.
22.
StarfieldB, WrayC, KessK, GrossR, BirkPS, D'LugoffBC. The influence of patient-practitioner agreement on outcome of care. Am J Pub Health1981; 71 (2):127–131.
23.
StewartMA. Effective clinician-patient communication and health outcomes: a review. Can Med Assoc J1995; 152: 1423–1433.
24.
MacDonaldN, MountB, BostonW, ScottJF. The Canadian palliative care undergraduate curriculum. J Cancer Educ1993; 8: 197–201.
25.
QvarnstromU.International standards provide guidelines for curriculum content. J Palliat Care1988; 4: 38–40.
26.
FieldMJ, CasselCK. Approaching Death: Improving Care at the End of Life.Washington, DC:Institute of Medicine Committee on Care at the End of Life, National Academy press, 1992.
27.
BillingsJA, BlockS.Palliative care in undergraduate medical education. JAMA1997; 278 (9):733–738.
28.
DickinsonGE, PearsonAA. Differences in attitudes towards terminal patients among selected medical specialties of physicians. Med Care1979; 17 (6):682–685.
29.
DickinsonGE, TournierRE. A decade beyond medical school: a longitudinal study of physicians’ attitudes towards death and terminally ill patients. Soc Sci Med1994; 38 (10):1397–1400.
30.
DurandRP, DickinsonGE, SumnerED, LancasterCJ. Family physicians’ attitudes towards death and the terminally ill patient. Fam Pract Res J1990; 9 (2):123–129.
31.
RuteckiGW, CuginoA, JarjouraD, KilnerJF, WhittierFC. Nephrologists’ subjective attitudes towards end-of-life issues and the conduct of terminal care. Clin Nephrol1997; 48 (3):173–178.
32.
PortaM, BusquetX, JariodM.Attitudes and views of physicians and nurses towards cancer patients dying at home. Palliat Med1997; 11: 116–126.
33.
LevinML, BerryJI, LeiterJ.Management of pain and terminally ill patients: physician reports of knowledge, attitudes, and behavior. J Pain Symptom Manage1998; 15 (1):27–40.
34.
BatesDW, TolleSW, ElliottDL. Subspecialty differences in responding to patient death – comparing cardiologists with oncologist. West J Med1988; 148 (4):471–473.
35.
FeinbergAW. The care of dying patients. Ann Intern Med1997; 126: 164–165.
36.
HintonJ.An assessment of open communication between people with terminal cancer, caring relatives, and others during home care. J Palliat Care1998; 14: 15–23.
37.
OddiLF, CassidyVR. The message of SUPPORT: change is long overdue. J Prof Nurs1998; 14 (3):165–174.
38.
MurrayFrommelt KH.The effects of death education on nurses’ attitudes towards caring for terminally ill persons and their families. Am J Hosp Palliat Care1991: 37–43.
39.
PrigersonHG. Socialization to dying: social determinants of death acknowledgment and treatment among terminally ill geriatric patients. J Health Soc Behav1992; 33: 378–395.
40.
MiyajiN.The power of compassion: truth-telling among American doctors in the care of dying patients. Soc Sci Med1993; 36 (3):249–264.
41.
CraneD.The Sanctity of Social Life.New York:Russell Sage Foundation, 1975.
42.
CicchettiDV, FleissJL. A comparison of the null distributions of weighted kappa and the ordinal statistic. Appl Psychol Meas1977; 1: 195–201.
43.
CicchettiDV, SparrowSS. Developing criteria for establishing inter-rater reliability of specific items: applications to assessment of adaptive behavior. Am J Mental Defic1981; 86 (2):127–137.
44.
CronbachLJ. Coefficient alpha and the internal structure of tests. Psychometika1951; 51: 297–334.
45.
MessickS.The standard problem: meaning and values in measurement and evaluation. Am Psychol1975; 30: 955–966.
CicchettiDV, VolkmaeF, KlinA, ShowalterD.Diagnosing autism using ICD-10 criteria: a comparison of neural networks and standard multivariate procedures. Child Neuropsychol1995; 1: 26–37.
48.
AndersonJC, GerbingDW. The effect of sampling error on convergence, improper solutions, and goodness-of-fit indices for maximum likelihood confirmatory factor analysis. Psychometrika1984; 49: 155–173.
