Update on end-of-life care training during nephrology fellowship: a cross-sectional national survey of fellows

Am J Kidney Dis. 2015 Feb;65(2):233-9. doi: 10.1053/j.ajkd.2014.07.018. Epub 2014 Sep 20.


Background: Patients with end-stage renal disease have high mortality and symptom burden. Past studies demonstrated that nephrologists do not feel prepared to care for their patients at the end of life. We sought to characterize current palliative and end-of-life care education received during nephrology fellowship and compare this with data from 2003.

Study design: Cross-sectional online survey of second-year nephrology trainees. Responses were compared to a similar survey in 2003.

Setting & participants: 104 US nephrology fellowship programs in 2013.

Measurements: Quality of training in and attitudes toward end-of-life care and knowledge and preparedness to provide nephrology-specific end-of-life care.

Results: Of 204 fellows included for analysis (response rate, 65%), significantly more thought it was moderately to very important to learn to provide care at end of life in 2013 compared to 2003 (95% vs 54%; P<0.001). Nearly all (99%) fellows in both surveys believed physicians have a responsibility to help patients at end of life. Ranking of teaching quality during fellowship in all areas (mean, 4.1±0.8 on a scale of 0-5 [0, poor; 5, excellent]) and specific to end-of-life care (mean, 2.4±1.1) was unchanged from 2003, but knowledge of the annual gross mortality rate for dialysis patients was nominally worse in 2013 because only 57% versus 67% in 2003 answered correctly (P=0.05). To an open-ended question asking what would most improve fellows' end-of-life care education, the most common response was a required palliative medicine rotation during fellowship.

Limitations: Assessments were based on fellows' subjective perceptions.

Conclusions: Nephrology fellows increasingly believe they should learn to provide end-of-life care during fellowship. However, perceptions about the quality of this teaching have not improved during the past decade. Palliative care training should be integrated into nephrology fellowship curricula.

Keywords: Nephrology fellowship; competency; dialysis; dialysis withdrawal; end-of-life; end-stage renal disease (ESRD); geriatrics; hospice; medical education; medical training; pain management; palliative care; survey.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Attitude of Health Personnel*
  • Cross-Sectional Studies / methods
  • Female
  • Humans
  • Internet*
  • Internship and Residency / methods*
  • Kidney Failure, Chronic / diagnosis
  • Kidney Failure, Chronic / therapy*
  • Male
  • Middle Aged
  • Pilot Projects
  • Terminal Care / methods*
  • United States