Leading medical textbooks "provide little information that would help a physician care for a dying patient," according to a review by researchers from George Washington University.
"For the common causes of death that we investigated," the researchers concluded, "we found that physicians cannot turn to general medical textbooks for guidance about advanced care planning, decision making, the effect of death and dying on a patient's family, or symptom management."
Frankness about death was "strikingly absent" from the textbooks, the researchers found. What little information was included, they said, tended to be vague, unhelpful and filled with euphemisms, such as referring to dead people as "nonsurvivors."
The textbook review was conducted by researchers from George Washington's Center to Improve Care of the Dying. Their results are in this week's Annals of Internal Medicine.
"It is no wonder that doctors so often fail their dying patients," said Joanne Lynn, director of the center and coauthor of the study. "We have not focused research or education efforts on these issues, and even our standard textbooks ignore the subject."
The researchers evaluated four widely used textbooks: "Harrison's Textbook of Medicine," "The Merck Manual," "Scientific American Medicine" and "Manual of Medical Therapeutics." They checked for references to nine aspects of care for dying patients and 12 common causes of death: AIDS, dementia, chronic lung disease, congestive heart failure, kidney failure, cirrhosis of the liver, diabetes, stroke and four types of cancer. For each disease and textbook, two reviewers noted and evaluated every reference to death, dying or fatality.
Dying issues with dementia, AIDS, lung cancer and breast cancer received the most comprehensive coverage, the study found.
In response to the findings, the authors said, at least two of the textbooks - "The Merck Manual" and "Scientific American Medicine" - have agreed to improve coverage of end-of-life care in their next editions.
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