Hospital Dr News

Juniors feel out of their depth with the end-of-life decisions during Covid-19

High numbers of deaths taking place in hospitals during the COVID-19 pandemic, frequently out-of-hours, has meant foundation level doctors having to lead on end-of-life discussions with families.

Research suggests that many of these junior doctors feel ill-equipped for the role but that with experience their confidence has improved.

In normal times, end-of-life care discussions are most commonly led by senior doctors.

An anonymous online survey of 75 foundation doctors based at Croydon University Hospital and other doctors at equivalent level at the trust revealed that 51% found that the pandemic increased resuscitation discussions ‘a lot’.

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.

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.

Key resources

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.

Research author Dr Edmund Lodwick, King’s College Hospital NHS Trust, said: “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.

“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.”
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