Many junior doctors feel out of their depth with the end-of-life decisions faced during COVID-19 pandemic

January 20, 2021

In normal times, end-of-life care discussions are most commonly led by senior doctors. However, new research from a busy London hospital shows that the high numbers of deaths taking place in hospitals during the COVID-19 pandemic, frequently out-of-hours, is leading to junior (foundation level) doctors having to lead on these difficult discussions with families, often with no formal experience or training.

The study is by Dr Edmund Lodwick, King's College Hospital NHS Trust, London, UK, and presented at this month's Winter Scientific Meeting of the Association of Anaesthetists, held online. He analysed the situation at Croydon University Hospital, London, where he spent his own foundation level training. This is a typically busy London hospital trust hit badly in the first wave of the pandemic, and again now during this latest surge in cases caused by the new SARS-CoV-2 variant in the UK.

He explains: "During the COVID-19 pandemic Croydon University Hospital faced a high number of critically unwell patients in short period of time. Unfortunately, this resulted in much greater need for discussions regarding treatment escalation and resuscitation with both patients and families. It was observed that complex discussions regarding these topics were often conducted by junior doctors, and that in many cases junior doctors would be engaging in discussions that may have been deemed exceptionally challenging for even the most experienced doctors."

These junior-level doctors had expressed concerns regarding the impact of the pandemic on resuscitation discussions, as well as a lack of postgraduate preparation for complex discussions and the difficulties of misinformation regarding resuscitation among the public. Dr Lodwick says: "As the pandemic slowed, we aimed to formally assess a number of these issues, in order to understand what could be improved upon. This was deemed exceptionally important given the risk of a 'second wave' and the arrival of a new cohort of junior doctors in August 2020."

He conducted an anonymous online survey of 75 foundation doctors based at Croydon University Hospital and other doctors at equivalent level at the trust (for example international doctors doing their training there). The survey consisted of nine questions (see notes below), and included: pre and post-COVID, how confident do you feel leading discussions regarding resuscitation? Has the COVID-19 pandemic increased the number of resuscitation discussions you have had with patients/family members? The response rate to the survey was 52%. Junior doctor confidence in handling resuscitation discussion in the pre-COVID-19 period was mixed, but generally low. This confidence increased during the pandemic as they handled more cases.

All foundation doctors surveyed had had no postgraduate training in resuscitation discussions. Dr Lodwick explains there is currently no formal requirement for junior doctors to be specifically trained in this area. Half of the doctors surveyed (51%) found that the pandemic increased resuscitation discussions 'a lot'. Foundation doctors also frequently found patients to be misinformed regarding resuscitation. Close to two thirds (62%) of foundation doctors found themselves out of their depth during resuscitation discussions 'a lot'.

Almost all (94%) did not know of specific resources available to doctors to aid in discussions regarding resuscitation, and again almost all (97%) did not know of specific resources available to patients to clarify questions regarding resuscitation. Resources include leaflets and booklets from organisations such as the Resuscitation Council and end of life charities, as well as links to online material. These are aimed at both healthcare professionals and the general public.

Dr Lodwick says: "The most significant finding of this audit showed the majority of respondents found themselves to be out of their depth when discussing resuscitation. This is likely due to their lack of formal training and clinical experience in leading these discussions. There is a clear lack of awareness of any resources that can be of use in these discussions. Further research is needed to establish the impact of these findings on patient care."

He adds: "In the context of the current wave of COVID-19 we are facing due to the new variant in the UK, the issues highlighted in this research are potentially even more severe than in the first wave, given the unprecedented strain on staff over this winter - pressure that is currently growing by the day. While further research is needed from other hospitals, it is likely this same problem is being experienced by junior doctors up and down the country. Further research and training in this area would help to guide a widespread series of interventions to empower junior staff nationwide in dealing with these extremely challenging end-of-life situations."


Related Science Articles from Brightsurf:

75 science societies urge the education department to base Title IX sexual harassment regulations on evidence and science
The American Educational Research Association (AERA) and the American Association for the Advancement of Science (AAAS) today led 75 scientific societies in submitting comments on the US Department of Education's proposed changes to Title IX regulations.

Science/Science Careers' survey ranks top biotech, biopharma, and pharma employers
The Science and Science Careers' 2018 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.

Science in the palm of your hand: How citizen science transforms passive learners
Citizen science projects can engage even children who previously were not interested in science.

Applied science may yield more translational research publications than basic science
While translational research can happen at any stage of the research process, a recent investigation of behavioral and social science research awards granted by the NIH between 2008 and 2014 revealed that applied science yielded a higher volume of translational research publications than basic science, according to a study published May 9, 2018 in the open-access journal PLOS ONE by Xueying Han from the Science and Technology Policy Institute, USA, and colleagues.

Prominent academics, including Salk's Thomas Albright, call for more science in forensic science
Six scientists who recently served on the National Commission on Forensic Science are calling on the scientific community at large to advocate for increased research and financial support of forensic science as well as the introduction of empirical testing requirements to ensure the validity of outcomes.

World Science Forum 2017 Jordan issues Science for Peace Declaration
On behalf of the coordinating organizations responsible for delivering the World Science Forum Jordan, the concluding Science for Peace Declaration issued at the Dead Sea represents a global call for action to science and society to build a future that promises greater equality, security and opportunity for all, and in which science plays an increasingly prominent role as an enabler of fair and sustainable development.

PETA science group promotes animal-free science at society of toxicology conference
The PETA International Science Consortium Ltd. is presenting two posters on animal-free methods for testing inhalation toxicity at the 56th annual Society of Toxicology (SOT) meeting March 12 to 16, 2017, in Baltimore, Maryland.

Citizen Science in the Digital Age: Rhetoric, Science and Public Engagement
James Wynn's timely investigation highlights scientific studies grounded in publicly gathered data and probes the rhetoric these studies employ.

Science/Science Careers' survey ranks top biotech, pharma, and biopharma employers
The Science and Science Careers' 2016 annual Top Employers Survey polled employees in the biotechnology, biopharmaceutical, pharmaceutical, and related industries to determine the 20 best employers in these industries as well as their driving characteristics.

Three natural science professors win TJ Park Science Fellowship
Professor Jung-Min Kee (Department of Chemistry, UNIST), Professor Kyudong Choi (Department of Mathematical Sciences, UNIST), and Professor Kwanpyo Kim (Department of Physics, UNIST) are the recipients of the Cheong-Am (TJ Park) Science Fellowship of the year 2016.

Read More: Science News and Science Current Events is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to