Largest Study Ever Published on End-of-Life Care

January 9, 2012

Jignesh Veragiwala, M.D., a Mercy family

medicine physician in Guthrie, Okla., with

a patient.

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Day in and day out, nurses and doctors care for dying patients. It’s what they do. But in an effort to provide some transparency around a difficult topic, Mercy has spearheaded a study revealing physicians experience a good dose of anxiety when it comes to caring for dying patients. The study, recently published online by the American Journal of Hospice & Palliative Medicine, will be published in print in March.

“This is the first time a study of this magnitude has looked at doctors’ attitudes in the United States concerning the care of dying patients,” said Gary Parker, PhD, MS, BSN, lead author of Mercy’s end-of-life study. “Several years ago Mercy did a similar study with nurses in the U.S., compared to those in China, and we found similar levels of apprehension.”

The study – which represents 622 of Mercy’s more than 5,000 physicians across Arkansas, Kansas, Missouri and Oklahoma – found that roughly over 75 percent have a moderate anxiety level when dealing with terminally ill patients. Oncologists, pediatricians and surgeons in particular have an even higher discomfort.

“Our research confirmed something that no one really wants to talk about in the U.S., and that’s dying,” said Tim Smith, M.D., vice president of research for Mercy’s Center for Innovative Care, and one of the study’s authors. “This research didn’t show us anything we didn’t already know. We know it’s difficult emotionally to deal with dying patients, but what this study does confirm is the need for physicians to have additional training and greater support systems in dealing with dying patients and their families.”

Each of the physicians in the study completed a 38-question survey, the Professional End-of-Life Attitude Scale (PEAS), that measures the differences in attitudes by medical specialty, gender and years of experience. Survey statements included a comfort scale of the following:

  • I am acting unprofessional if I cry in front of a dying patient or his/her family.
  • It is hard to know what to say when I have to talk with a patient about a terminal prognosis.
  • I try to avoid telling a patient directly that he/she is dying.

The survey also reviewed whether the physicians had studied about caring for terminal patients in medical school and whether they themselves had a living will in place.

“The fact of the matter is that patients rely heavily on their physicians to guide them through this difficult time,” said Dr. Smith. “If physicians are not skilled and comfortable in dealing with end-of-life issues, communication gaps and misinformation may occur.”

Because of the survey findings, Mercy plans to increase end-of-life education so physicians can better meet the challenges of administering end-of-life care, including lecture sessions and clinical visits to inpatient hospices.

“As a faith-based organization, we are not only committed to our patients’ medical health, but we are equally committed to providing spiritual and bereavement support,” said Sister of Mercy Mary Roch Rocklage, Mercy ministry liaison. “We treat the whole person, and in doing so we must provide emotional support, which includes being able to speak honestly about death with patients and their families, and also assure the patient is comfortable and not in pain as a part of their end-of-life care.”

Mercy also has plans to do a comparative study between doctor and nurse findings, eventually extending the study to doctors at The Sir Run Run Shaw Hospital in Hangzhou, China.

Mercy is the eighth largest Catholic health care system in the U.S. and serves more than 3 million people annually. Mercy includes 31 hospitals, more than 200 outpatient facilities, 38,000 co-workers and 1,500 integrated physicians in Arkansas, Kansas, Missouri and Oklahoma. Mercy also has outreach ministries in Louisiana, Mississippi and Texas. For more about Mercy, visit

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