A Prospective Controlled Trial To Improve the Care of Dying Patients on a General Medicine Inpatient Service

The Foundation's Generalist Physician Faculty Scholars Program was designed to strengthen the presence of generalist physician faculty in the nation's medical schools through career development awards to outstanding junior faculty in medical school departments/divisions of family medicine, general internal medicine and general pediatrics.Recent studies suggest that many patients suffer excessively at the end of life. Whether the cause is pain or spiritual crisis, the common pathway to treatment is through a provider that elicits these concerns and is equipped to address them. The goal of this grant is to integrate into a primary care medicine service a curriculum on palliative care for house staff and faculty that emphasizes skills for communicating with dying patients. They will evaluate the effect of this intervention on physician knowledge and behavior and on the quality of life for dying patients. The study will plan a prospective, controlled trial of this intervention in which all resident and attending physicians on the intervention service will receive the curriculum. This small group, learner-centered, skills-based curriculum will be integrated into a primary care medicine in-patient service. Residents will practice these skills with their patients and receive immediate feedback. Physicians on the control services will receive no targeted education. They will measure improvement in physician behaviors by rating their performance using standardized patients and will assess the effect of the intervention on patient outcomes by identifying prospectively all patients with an expected survival of less than six months and assessing several measures of physical and emotional well-being. After patients die, they will obtain physician, nurse, and family perspectives on the quality of their deaths. Care of the dying patient is primarily the responsibility of generalist physicians, yet evidence documents that many physicians do not possess adequate skills to effectively provide this care. This project will create and evaluate a generalizable model for educating primary care providers in the care of terminally ill patients.

Grant Details

Amount Awarded $239,886.00

Awarded on: 4/7/1997

Time frame: 7/1/1997 - 6/30/2002

Grant Number: 31492


Duke University Medical Center

2301 Erwin Road
Durham, 27705-4699


James Aaron Tulsky
Project Director