Common myths about caring for patients with terminal illness: Opportunities to improve care in the hospital setting

Abstract BACKGROUND Shortcomings in the quality of care of hospitalized patients at the end of life are well documented. Although hospitalists and residents are often involved in the care of hospitalized patients with terminal illness, little is known about their knowledge and beliefs concerning terminal illness, despite the importance of such physicians to the quality of care at the end of life. DESIGN In 2006 we conducted an exploratory study at a large academic medical center to examine the knowledge, attitudes, and practices of hospitalists and residents (n = 52, response rate = 85.2%) about the care of terminally ill patients. Data were collected using a 22‐item survey instrument adapted from previously published instruments. RESULTS Several common myths about treating terminally ill patients were identified. These myths pertained to essential aspects of end‐of‐life care including pain and symptom control, indications for various medications, and eligibility for hospice. Physicians reported positive attitudes about hospice care as well as the belief that many patients who would benefit from hospice do not receive hospice at all or only late in the course of their illness. CONCLUSIONS Our findings identified misunderstandings that hospitalists and residents commonly have, including about facts essential to know in order to provide appropriate pain and symptom management. Future interventions to improve knowledge need to focus on specific clinical knowledge about opioid therapy, as well as information about eligibility rules for hospice. Journal of Hospital Medicine 2007;2:357–365. © 2007 Society of Hospital Medicine.