When the authors asked about the residents’ general satisfaction with discussion of code status, “we learned two things: one, the residents are significantly more satisfied with their own discussions than their attendings’ discussions; and two, there is a substantial minority that is dissatisfied with all discussions, and a small number who are actually very satisfied,” Dr. Einstein said.
In a linear regression analysis testing for hypothesized correlations, the investigators found that more-senior residents were more likely to share prognostic information and make recommendations (P = .002). Residents who expressed an interest in hematology/oncology or palliative care specialization were also more likely to offer prognostic information, but not to make a recommendation about code status.
More-senior year of training correlated negatively with satisfaction with both the resident’s own and the attending’s discussion of code status.
“We found substantial dissatisfaction with code-status discussions in general, and we hypothesize that this is due to an internal conflict. When a resident knows that an intervention may be more harmful than beneficial, but thinks that the patient should make their own decision alone, then one may experience substantial frustration, and this would increase as training goes on and one becomes more sure of the outcomes of interventions like CPR,” Dr. Einstein said.
Generation gap
Evoking a potential generation gap between old-school doctors and the up-and-coming young physicians who by statute work fewer hours than their mentors had to, “I’m struck that [residents] don’t trust the attendings. When I was a resident, you didn’t do anything without asking the attending,” said Dr. Michael H. Levy, an invited discussant who is vice chair of medical oncology and director of the pain and palliative care program at Fox Chase Cancer Center, Philadelphia.
“I’m glad that the residents want to do it, but they have the same arrogance/ignorance that they don’t know how, so if we want them to do it, we have to train them,” he said.
The symposium was cosponsored by AAHPM, ASCO, ASTRO, and MASCC. The study was supported in part by the Conquer Cancer Foundation. Dr. Einstein and Dr. Levy reported having no relevant disclosures.