to the editor: The article, “End-of-Life Care Content in 50 Textbooks from Multiple Specialties” in a recent issue of JAMA1 concluded “that top selling medical textbooks offered little helpful information on caring for patients at the end of life.” The authors reported that family medicine, geriatrics and psychiatry textbooks have the greatest volume of helpful content on end-of-life (EOL) care. One third of the chapters in family medicine textbooks were found to have helpful content on EOL care, and 20 percent were considered to have minimal content, while 45 percent had no content. Geriatrics and psychiatry textbooks had a similar pattern.
This same study1 found that family medicine textbooks had better content in chapters on Alzheimer's disease, death and dying, and chronic obstructive pulmonary disease, compared with chapters on lung cancer, coronary artery disease and cerebrovascular accident. Chapters in family medicine textbooks on trauma, leukemia and adult respiratory distress syndrome were worse than chapters found on these subjects overall. The authors considered 13 domains from all elements of EOL care.
These findings should please family physicians but should also inspire continuous efforts in EOL care. EOL care competence can be addressed in various ways for the family physician. American Family Physician and other family medicine journals should continue to publish articles on EOL care. The AFP articles on advance directives is an excellent example.2 A series covering the above mentioned 13 domains might be considered. Lectures, workshops and seminars at scientific meetings provide an excellent forum to provide training on EOL care.
The American Academy of Family Physicians' continuing medical education program could consider an EOL care conference. The residency core educational guidelines include a section on EOL care. The American Board of Family Practice ensures coverage in the certification examination with 12 percent devoted to geriatrics and may consider EOL care as a possible office record review topic. And, we appeal to textbook editors to bolster their EOL care content. We are covering EOL care in these forums, and I entreat those involved to ensure our competence in EOL care.
I'm sure that family physicians—academicians, writers, speakers, researchers and clinicians—are aware of the progress to-date, and the current status of EOL care education and training, and will continually lead the way in EOL care. I recommend that all family physicians read this article for better awareness of this important, but sometimes neglected topic.2 (Editor's note: A more recent article on EOL care is available for review [Ackermann RJ. Withholding and withdrawing life-sustaining treatment. Am Fam Physician 2000;62: 1555–60,62,64].) Family physicians who are competent in EOL care, improved through comprehensive education and training, will continue to provide quality medical care to their patients.