George E. Dickinson

Detached concern and death anxiety of first‐year medical students: Before and after the gross anatomy course

The purpose of this study was to gather data from first‐year medical students prior to their taking gross anatomy and again at the end of the course to determine if changes occur regarding death anxiety and detached concern toward patients. Chi‐square and t‐tests were used to assess statistical significance. From the 84 students for whom we had data both prior to and after gross anatomy, only the sociodemographic variable of sex was consistently related to the two dependent variables. Women reported more death anxiety prior to and after the gross anatomy course and were more likely to disagree with the need for detached concern. Clin. Anat. 10:201–207, 1997.

Death education in selected health professions

Health professionals have a high probability of working with populations experiencing death and other types of loss. Surveys of medical, nursing, pharmacy, dental, and social work schools in the United States to determine their offerings in thanatology revealed that the majority (with the exception of dentistry) offer some education on death and dying. Because most of the offerings are limited to one or two lectures, a high percentage of students are graduating with limited formal exposure in this area. However, offerings have come a long way since the early 1970s.

Teaching end-of-life issues: Current status in United Kingdom and United States medical schools

Our objective was to determine how broadly end-of-life issues are represented in the undergraduate medical school curricula of the United Kingdom (UK) and the United States (US). Mailed surveys yielded response rates of 100 percent in the UK and 92 percent in the US. With one exception, all medical schools in the survey offered some exposure to dying, death, and bereavement and most addressed the topic of palliative care. Hospice involvement was found in 96 percent of UK medical schools but in only 50 percent of US schools. Overall, the UK appears to provide more exposure to end-of-life issues in medical schools, although the US appears to be moving in that direction.

Hospice referral decisions: The role of physicians

In our study, we collected and evaluated the opinions of physicians in the Lowcountry of South Carolina (Berkeley, Charleston, and Dorchester counties) regarding their referrals to hospice programs and the extent of influence that their patients and families had on the decision. The research questionnaire was sent to 362 physicians who made referrals to hospice (53 percent response rate) and to 337 physicians who did not make referrals (40 percent response rate). Results revealed that medical doctors take the initiative in referrals. They felt that late referrals were due to reluctance on the part of the patient and the patient’s family to admit that death was imminent. No differences were found in age, sex, medical specialty, percent of terminally ill patients per practice, or initiative taken. However, when the age and sex of physicians were evaluated, a statistically significant difference was found; females younger than 45 years of age were more likely to make referrals than younger males. Younger physicians were more likely to perceive that the family’s reluctance to admit that death was near was a barrier to hospice referrals.

Teaching End-of-Life Issues in US Medical Schools: 1975 to 2005

This study examined medical school offerings on end-of-life issues between 1975 and 2005. Seven national surveys of US medical schools were conducted in 1975, 1980, 1985, 1990, 1995, 2000, and 2005 (response rates in percentages of 95, 96, 90, 90, 93, 92, and 81, respectively). Results revealed that between 1975 and 2005, the overall offerings in death and dying increased so that 100% of US medical schools, beginning in 2000, offered something on death and dying. A multidisciplinary-team approach continued over the 30-year period. Palliative care is offered in 94% of US medical schools, to some extent, and about a fourth of the schools offer students an opportunity to have a continuing relationship for several weeks with a terminally ill patient. Numerous end-of-life topics are currently covered in the curriculum. This increased attention to end-of-life issues in medical schools should enhance each medical student’s relationship with terminally ill patients and their families.

Characteristics of prison hospice programs in the United States.

Hospice programs have emerged over the last 40 years as both an effective and humane practice for responding to terminal illnesses in the free society. More recently, hospice has diffused throughout state, federal, and municipal correctional systems. Thus, we sought via a mailed survey of the 69 known prison hospice programs in the United States (response rate of 62%) to determine how prison hospice programs were similar or dissimilar to hospices in the free society. Our findings suggest that prison hospices have a more stringent screening process for volunteers and require more volunteer training prior to interacting with a hospice patient. Prison hospice programs tend to follow both the National Prison Hospice Association and the GRACE Project guidelines.

A quarter century of end-of-life issues in U.S. medical schools.

This study examined medical school offerings on end-of-life issues between 1975 and 2000. Five national surveys of US medical schools were conducted in 1975, 1980, 1985, 1995, and 2000 (response rates of 95%, 96%, 9 0%, 93%, and 92%, respectively). Results revealed that between 1975 and 2000, the offerings in death and dying increased. A multidisciplinary-team approach continued over the 25-year period. In 2000,palliative care was directly addressed in 87% of medical schools responding, and the majority of students were exposed to a hospice patient.The increased attention to death and dying in medical schools should enhance the medical students relationship with terminally ill patients. An awareness of, and acquired knowledge about, these issues in the medicalization of students should result in end-of-life concerns being more tolerable for both patients, their families, and physicians.

U.K. PHYSICIANS'ATTITUDES TOWARD ACTIVE VOLUNTARY EUTHANASIA AND PHYSICIAN-ASSISTED SUICIDE

A comparison of the views of geriatric medicine physicians and intensive care physicians in the United Kingdom on the topics of active voluntary euthanasia and physician-assisted suicide revealed rather different attitudes. Eighty percent of geriatricians, but only 52% of intensive care physicians, considered active voluntary euthanasia as never justified ethically. Gender and age did not play a major part in attitudinal differences of the respondents. If the variability of attitudes of these two medical specialties are anywhere near illustrative of other physicians in the United Kingdom, it would be difficult to formulate and implement laws and policies concerning euthanasia and assisted suicide. In addition, ample safeguards would be required to receive support from physicians regarding legalization.

A decade beyond medical school: A longitudinal study of physicians' attitudes toward death and terminally-ill patients

Physicians were surveyed soon after graduation from medical school in 1976 to determine their attitudes toward death and terminally-ill patients and their families. A follow-up survey of the 1093 respondents was made in 1986 to ascertain if changes had occurred in their attitudes. Eight of the eleven Likert-type items showed statistically significant differences over time and by attitudes toward terminally-ill patients and their families. These data present evidence to suggest that physicians in 1986 were more open in telling dying patients their prognosis than in 1976.

First Childhood Death Experiences.

A childs first experience with death may be met with a variety of responses. The objective of this research was to determine what adults remember about these early death experiences. Students in college death-and-dying classes were asked to write an essay about their first death experience. The average age of the respondents (N = 440) was 23.79 years, and their average age at the time of their first death experience was 7.95 years. Content analysis was used to analyze the essays. Over half of all first experiences with death involved relatives, 28 percent involved a pet. Childrens responses to death showed emotions similar to those expressed by adults. Over one-third mentioned that crying occurred. Details of the funeral were remembered by many respondents some sixteen years later. Adults need to be sensitive to the needs of children when a significant other or pet dies. It is clear that childhood experiences flavored with death, loss, or separation can become important influences on the way one sees life and copes with death.