• B R Jarabek, A A Jama, S S Cha, S R Ruegg, T J Moynihan, and F S McDonald.
• Internal Medicine Residency Programme, Mayo Clinic, Rochester, MN 55905, USA. jarabek.bryan@mayo.edu
• Palliat Med. 2008 Jun 1;22(4):343-9.

AbstractAlthough one-fourth of all medicare dollars are spent during the last year of life, symptom management for terminal hospitalized patients has continued to be inadequate. Quality end-of-life care is often overlooked, seldom taught and rarely measured within Internal Medicine Residency Programmes. We studied the effects of a palliative care order set and educational e-mail on resident comfort. Survey of residents showed that only 54% were comfortable across nine aspects of palliative care. Three months after release, 88% of residents were using the order set and 63% believed it increased their comfort with palliative care. Resident comfort managing palliative symptoms increased an average 10% (P = 0.02). First-year residents exposed to this order set increased in comfort from 40% to 65% (P < 0.0001), which significantly surpassed the 48% of second-year residents who reported being comfortable (P = 0.002). Introducing a palliative care order set improves resident comfort with symptom management in dying patients.

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