P-33 A survey of junior doctors’ confidence in providing end of life care

Background Palliative care is increasingly incorporated into undergraduate curriculums in UK medical schools. Training needs of junior doctors who frequently provide care for dying patients, however, are less well elucidated. Aim We set out to assess junior doctors’ confidence in various areas of End of Life Care in order to identify specific training needs. Method We adapted the University College London Hospital Care of the Dying Confidence Questionnaire to focus on areas of End of Life Care relevant to junior doctors. We distributed a paper and online version of this questionnaire to trainees in acute, surgical and medical specialties at the Royal Free NHS Foundation Trust. The statistical significance of the difference between Likert scale medians was determined by Kruskal-Wallis tests. Results We received 95 survey responses from doctors in foundation (71%), core (19%) and specialty registrar (10%) training years. Unsurprisingly, higher training grade was associated with increased confidence in providing End of Life Care, in particular in discussing dying and ceiling of care with patients and their family members. All trainees were confident (Likert median=6) in verifying death and writing death certificates. Trainees reported low confidence (Likert median=4) in discussing the discontinuation of nutrition and hydration as well as in caring for a dying patient who becomes unconscious. Conclusion Junior doctors are confident in skills routinely taught and tested during medical school. There remains a need for additional End of Life Care training, in particular for foundation trainees. To optimise the End of Life Care provided by junior doctors this training should focus on areas of low confidence such as discussing nutrition and hydration.