​Younger doctors are receiving much more instruction and training on how to address end-of-life issues with their patients than their predecessors, marking a trend for advances in the way Americans tackle the toughest of subjects in the palliative care and end-of-life care spectrum, experts at a National Journal-sponsored discussion in Washington, D.C., said on Tuesday.

Ezekiel Emanuel, MD, senior fellow, Center for American Progress, said a new poll also sponsored by the National Journal and managed by FTI Consulting, shows physicians under 40 are more prepared for end-of-life care than veteran practitioners.

“No one told us to broach the subject,” Emanuel said, speaking of his over-40 generation. Since the mid-1990s there has been a major shift in the medical establishment to make end-of-life part of the education and training of new doctors, he noted.

“We’re doing better [end-of-life care], but it will take a long time to filter down,” Emanuel said. Nobody likes to think about the subject, having to break the news to a patient that care options have been exhausted and preparation for dying is the next step of their lives, he said.

“It is emotionally draining and it takes time,” Emanuel said. The hardest part for many doctors is how to even start the conversation. It may help in that regard if the patient is a long-time patient or one who has a destructive disease like cancer. It is more difficult with younger patients who come to their condition in an unexpected way and have family who cannot fathom end-of-life care.

“It’s not just pain management, which in fact is the easiest part of it [palliative care],” Emanuel says. There are symptoms that are hard to control like shortness of breath, there are mental health problems like depression, and there are spiritual and cultural considerations, he added.

Beyond the human elements, there are costs tied to the care options taken at the end of life, and even payment issues surrounding the time doctors spend with patients in hospitals or long term care settings.

Emanuel says cost has not been a major factor for his patients, with the transition to dying and the meaning of their lives much more important. Still, these are all issues doctors and all providers must be attuned to as they tackle the end of life.

“No one relishes that conversation,” he said, but with the improved training happening now, providers are better equipped to deal with the complexities in palliative and end-of-life care.

Tags: End of life