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Cited by 165Palliative Care and End-of-Life IssuesPalliative and Oncologic CareInnovations in Medical Education

The need for end-of-life care training in nephrology: national survey results of nephrology fellows

Holley, Jean L, Carmody, Sharon S, Moss, Alvin H, Sullivan, Amy M, Cohen, Lewis M, Block, Susan D, Arnold, Robert M·2003·American Journal of Kidney Diseases
DOI 10.1016/s0272-6386(03)00868-0
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Abstract

Because of the high mortality rate of end-stage renal disease, nephrologists care for many dying patients. However, the education of nephrology fellows in palliative care has not been assessed. We surveyed second-year nephrology fellows to assess the quantity and quality of teaching they received in palliative medicine and also asked about their preparedness to manage patients at the end of life. A 63% survey response rate yielded 173 surveys for evaluation. Nearly all fellows (99%) agreed that physicians have a responsibility to help patients at the end of life; half thought it was very important to learn how to care for dying patients. On a 10-point scale in which 0 is no teaching and 10 is a lot of teaching, fellows reported significantly less teaching in end-of-life care (mean score, 3.8 +/- 2.6) than in managing a patient with distal renal tubular acidosis (mean score, 6.3 +/- 2.5) or on hemodialysis therapy (mean score, 8.9 +/- 1.5; all P < 0.0001). Specific palliative care content areas were taught infrequently; only 22% of fellows were taught how to tell a patient he or she is dying. Fellows who had contact with a palliative care specialist reported more education on end-of-life issues and believed they were better prepared to provide such care. Fellows' palliative care experiences during fellowship frequently occurred without attending nephrologist supervision; 32% of fellows had conducted 2 or fewer family meetings, and 26% of all family meetings occurred without an attending nephrologist. Fellows believed they were best prepared to manage a patient on hemodialysis therapy (mean score, 8.9 +/- 1) and least prepared to manage a patient at the end of life (mean score, 6.1 +/- 2; P < 0.0001). Our results show that most nephrology fellows believe they should learn how to care for dying patients, but most fellowship programs do not offer this training. Our study therefore suggests that training in palliative care be incorporated into fellowship program curricula.

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  • Nephrologists vary substantially in their attitudes and practices around end-of-life decisions, though these differences appear to be shrinking.

    “Studies show there is substantial variation in attitudes toward and practice of end-of-life decision making among nephrologists, although these differences seem to be lessening over time [36,37].”

    From Should there be an expanded role for palliative care in end-stage renal disease? (2010) · cites this paper as [36]

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Authors
Holley, J. L., Carmody, S. S., Moss, A. H., Sullivan, A. M., Cohen, L. M., Block, S. D., & Arnold, R. M.
Affiliations
  • University of Virginia Health System (US)
  • University of Pittsburgh Medical Center (US)
  • West Virginia University (US)
  • Brigham and Women's Hospital (US)
  • Baystate Medical Center (US)
Corresponding author
Holley, Jean L
ORCID
Venue
American Journal of Kidney Diseases
Publisher
Elsevier BV
Published
2003-10
Volume
42
Issue
4
Pages
813-820
ISSN
0272-6386 (ISSN-L)
DOI
10.1016/s0272-6386(03)00868-0
OpenAlex
W2054749331
Cited by
165
References
15
Citations by year
2026: 1 · 2025: 2 · 2024: 2 · 2023: 6 · 2022: 4 · 2021: 7 · 2020: 5 · 2019: 8 · 2018: 10 · 2017: 7 · 2016: 15 · 2015: 12 · 2014: 13 · 2013: 11 · 2012: 10
FWCI
4.74
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • American Journal of Kidney Diseases (publishedVersion)
  • PubMed (publishedVersion)
  • DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
Keywords
end-of-life care, palliative care, nephrology fellowship training, nephrology fellows, end-stage renal disease, physician preparedness, palliative care curriculum, family meetings
MeSH terms
Data Collection, Demography, Fellowships and Scholarships, Female, Humans, Male, Nephrology, Palliative Care, Teaching, Terminal Care

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