The American Journal of Hospice and Palliative Medicine recently published a study suggesting that the longer a student is in medical school, the less likely the student is to perceive the goals of hospice patients.¹ What do patients near the end of life value in their care? How does this differ from what doctors think hospice patients want? Most importantly, how do we bridge that gap?

The Importance of Empathy and Value-Concordant Medical Care

Medical leaders include the ability to identify and respect patient differences, preferences, and needs as a core competency of any healthcare professional.² When patients perceive their care as empathetic, a number of benefits accrue. The benefits of clinician empathy include greater patient satisfaction,³ the perception of fewer medical errors,⁴ decreased anxiety,⁵ and improved treatment adherence.⁶ Nevertheless, medical students and residents often cite a lack of training in end-of-life care, report feeling unprepared with dying patients, and express discomfort with engaging in end-of-life conversations.^7,8  

Fortunately, in actual clinical practice, families report that most end-of-life care matches patient preferences. Family caregivers report receiving value-concordant care in the last month of life 87% of the time.

What Do Hospice Patients Value?

In the current study, Kathryne Levy and colleagues from State University of New York, surveyed eighty hospice patients. Patients ranked a list of goals in order of importance. Here is how the group ranked them.

1. Not being a burden to family
2. Time with family and friends
3. Pain and symptom management
4. Being at peace with God
5. Being mentally aware
6. Dying at home
7. Having care directives followed
8. Feeling that life was meaningful
9. Living as long as possible
10. Having finances in order
11. Resolving conflicts

Medical Student Perceptions of Hospice Patient Goals

The study also had 97 first-year medical students and 79 third-year medical students perform the same exercise to report their perception of how hospice patients would rank the goals. Levy et al report “major discrepancies” between hospice patients and medical students, with 7 of the 11 goals ranked significantly differently. Medical students tended to underrate the goals of not being a burden to family, being at peace with God, dying at home, and living as long as possible. Medical students tended to overrate feeling that life was meaningful and resolving conflicts. Interestingly, first-year medical students proved to have a better perception of hospice patient goals than third-year medical students.

Medical Student Empathy and Communication Skills

Importantly, this study analyzed perceptions of groups and did not measure how these perceptions specifically affect patient care, if at all. Ultimately, caring for patients near the end of life involves conversations about life expectancy, patient goals, and collaborative care planning. None of these skills and procedures were measure in the current study.

Another encouraging note is the study’s secondary measure of medical student empathy. The medical students also completed the Interpersonal Reactivity Index – a validated tool for measuring empathy. First-year medical students scored as having much higher empathy than the general population, and this characteristic did not dissipate through the years of medical school.

References

1. Levy K, Grant PC, Kerr CW, Byrwa DJ, Depner RM. Hospice Patient Care Goals and Medical Students’ Perceptions: Evidence of a Generation Gap?. American Journal of Hospice and Palliative Medicine®. 2021 Feb;38(2):114-22.
2. Baker A. Crossing the quality chasm: a new health system for the 21st century. British Medical Journal Publishing Group; 2001 Nov 17.
3. Wang H, Kline JA, Jackson BE, Laureano-Phillips J, Robinson RD, Cowden CD, d’Etienne JP, Arze SE, Zenarosa NR. Association between emergency physician self-reported empathy and patient satisfaction. PloS One. 2018 Sep 13;13(9):e0204113.
4. Hannan J, Sanchez G, Musser ED, Ward-Peterson M, Azutillo E, Goldin D, Lara EG, Luna AM, Galynker I, Foster A. Role of empathy in the perception of medical errors in patient encounters: a preliminary study. BMC Research Notes. 2019 Dec;12(1):1-5.
5. Weiss R, Vittinghoff E, Fang MC, Cimino JE, Chasteen KA, Arnold RM, Auerbach AD, Anderson WG. Associations of Physician Empathy with Patient Anxiety and Ratings of Communication in Hospital Admission Encounters. Journal of Hospital Medicine. 2017 Oct;12(10):805-10.
6. Kim SS, Kaplowitz S, Johnston MV. The effects of physician empathy on patient satisfaction and compliance. Evaluation & the Health Professions. 2004 Sep;27(3):237-51.
7. Schmit JM, Meyer LE, Duff JM, Dai Y, Zou F, Close JL. Perspectives on death and dying: a study of resident comfort with End-of-life care. BMC Medical Education. 2016 Dec 1;16(1):297.
8. Romotzky V, Galushko M, Düsterdiek A, Obliers R, Albus C, Ostgathe C, Voltz R. “It’s not that easy”—medical students’ fears and barriers in end-of-life communication. Journal of Cancer Education. 2015 Jun 1;30(2):333-9.