A team of researchers from several Pennsylvania institutions conducted the survey to determine if and when doctors receive training to care for people who are dying, the nature of any such training, and areas that should be included in future training. Of 120 questionnaires distributed, 90 were returned.

Results of the study showed:

• Doctors lack standardized training in working with the terminally ill, ? They want periodic, continuous training, and it should be mandatory and ongoing,
• They would like training in pain management, death and dying, quality of life and death, and "do not resuscitate" orders, and
• They believe training in the care of dying people should begin in medical school and continue throughout their careers.

The authors of the study found medicine is a profession of action (perform more tests, order medication), and therefore precludes gestures that dying patients find comforting. "Specifically, there is value in being present to talk, to listen or to simply be there, not on the run, not distracted, just present in someone else?s suffering," they wrote.

The Care They Need Changes in health care tend to focus on altering the system of care, not on the care itself. "The central importance of the patient is lost, and the importance of the patient-physician relationship is often not considered," the researchers wrote. "The result is a system of health care that fails to provide adequate training for dealing with the end of life and an economic engine that does not value the ?soft? part of health care."

Mary Simmonds, MD, a medical oncologist in Harrisburg, Pa., and a member of the American Cancer Society?s National Board of Directors and the Society?s Advisory Group on Quality of Life, described the study as "very encouraging" and said there is a definite need for better training in caring for terminally ill patients. Regarding pain management, Dr. Simmonds said pain is under treated, and the reasons for this are complex.

Pain Management "People don?t tell their doctors [about the pain]. They don?t want to distract them from what?s going on, particularly if they know the cancer is going to kill them. They don?t want to take the doctor?s time. Or they believe they just need to be stoic or need to suffer to get better," she said.

"From the physicians? point of view, they [physicians] may not have a lot of time? which is no excuse, but it?s a reason. Many physicians are not very well versed in pain management. There are a lot of misconceptions that doctors as people bring into this, but there clearly is a lack of education," Dr. Simmonds added.

An important part of the study was to find out when participants thought training in caring for the dying would be the most effective. Responses, in order of most to least important, were (1) during medical school; (2) as an intern; (3) as a resident; (4) as a fellow; and (5) as an attending physician.

The most frequently picked forum for training was group discussion, followed by seminars. The least selected was the lecture format, which participants reported as being the format in which they most frequently received training.