We endeavoured through this investigation to better understand the residents' experience; to promote exchange of values between residents and patients; and to inform the development and evaluation of EOL decision-making teaching tools.
Of the 73% of Canadians who die in hospital, roughly 20% die in special care units where trainees are the health professional most likely to establish code status â€“ the decision regarding limitation of therapy â€“ which determines the level of care. There is limited information however as to how trainees experience end-of-life decision making. We interviewed 21 trainees in nine specialty critical care programs across Canada with backgrounds in internal medicine, anesthesia, and surgery. The interviews were highly emotional; participants mostly expressed suffering in terms of sadness and fear, or complex emotions such as distress, grief, and guilt; they expressed gratitude for the opportunity to tell their stories. The narrative has been described as a tool for healing in the context of illness and as a crucial instrument in transforming suffering.
Our data suggest that narration should be considered as a tool in the context of EOL decision making and may help us teach residents how to face the suffering of others as well as their own. As program director for adult critical care at the Universite de Montreal, national specialty committee member in critical care medicine, and vice-president of the national internal medicine examination jury, RESPECT PI YS has been well situated to influence curriculum and educational initiatives arising from the Royal College that relate to end of life care. These data were presented by YS at the Critical Care Forum Canada, November 2007.
The medical resident evaluation survey highlights knowledge, attitudes, and confidence factors that may be addressed through educational strategies to improve EOL care; the RESPECT study provides insight into how past experience and values influence residents' reasoning pertaining to end-of-life conversations with patients and their families. These studies, coupled with our increased understanding of the lived experience of patients and families from our qualitative studies, will inform future educational interventions or initiatives.