Discussing End-of-Life in the Intensive Care Unit: Education Practices in Pulmonary and Critical Care Medicine Fellowship Programs

IntroductionEnd-of-life care (EOLC) is an important aspect of patient management in the Intensive Care Unit (ICU). Poor communication during this time can lead to unnecessary suffering for patients and their families. Although palliative training is required in Pulmonary and Critical Care Medicine (PCCM) fellowship programs, there is significant variability in its delivery, and data on its effectiveness are limited. This study evaluates the implementation and impact of EOLC communication instruction in PCCM fellowship programs.MethodsA web-based survey was administered to PCCM fellows in the United States from December 2023 to February 2024. Statistical analyses were conducted to assess factors influencing fellow confidence in leading EOLC discussions in the ICU.ResultsA total of 167 fellows completed the survey (response rate: 7.4%). Most respondents (61%) reported one or two types of EOLC training in their programs. Nearly half (53%) felt their training was adequate. Fellows who led more EOLC discussions were significantly more confident in doing so (<i>P</i> < 0.001). Greater confidence was also associated with smaller ICU census and stronger faculty mentorship (<i>P</i> < 0.05).ConclusionsPCCM fellows feel more confident in leading EOLC discussions when they have supportive faculty mentors, manageable ICU workloads, and ample experience with these conversations. As nearly half of fellows report insufficient training, integrating these strategies into fellowship curricula is essential for improving EOLC communication.