Regulatory and educational initiatives fail to promote discussions regarding end-of-life care

We conducted an observational cohort study to determine if hospital-based, reinforcing regulatory and educational interventions could encourage physic ians to discuss end-of-life (EOL) care with their patients. Specifically, w e measured the effect of (1) administrative prompts to encourage discussion s about EOL care and (2) a mandatory educational seminal focusing on EOL is sues. Study subjects were patients consecutively admitted to the medicine s ervice who faced an anticipated 3-year mortality rate of at least 50 %. The main study endpoint was the frequency of documented EOL discussions betwee n physicians and patients. In the inception cohort of 184 patients, physici ans discussed EOL care with 64 patients (34.8 %), and in the follow-up coho rt of 121 patients, 41 individuals (33.9 %) had documented discussions rega rding EOL issues (P = 0.90). Actual "Do Not Resuscitate"(DNR) orders were w ritten for 53 patients (28.8 %) in the inception cohort and for 33 persons (27.3 %) in the follow-up cohort (P = 0.71). We conclude that enhanced, mut ually reinforcing regulatory and educational efforts focusing on EOL care p roved ineffectual at promoting either discussions about EOL issues or the u se of DNR orders. (C) U.S. Cancer Pain Relief Committee, 2000.