CA proposal: Pain management ed required

A bill that would require the teaching of pain management in state-funded medical schools is making its way through the California state legislature. The state assembly passed the measure in June, and the senate is preparing its vote.

The proposal would add pain management and end-of-life care to the curriculum requirements for students entering medical school on or after June 1, 2000. It also requires health facilities licensed in the state to assess pain as it would assess other vital signs.

The bill specifies that the California Department of Aging act as a clearinghouse for information and materials needed to educate medical students and community education relating to advance directives.

If passed, the move would follow a recent study published in the June issue of Oncology Nursing Forum that pointed to the lack of end-of-life care training in nursing schools. The study reviewed 50 textbooks frequently used in nursing undergraduate schools, including 45,683 pages within 1,750 chapters. The texts were analyzed in depth using an analysis framework with consultation from end-of-life care experts. The findings revealed that only 2% of content and 1.4% of chapters were related to any end-of-life care topic. The nine critical areas of end-of-life issues examined in the textbook process were: Palliative Care Defined; Quality of Life; Pain; Other Symptom Management; Communication with Patients and Family Members; Role/Needs of Family Caregivers; Death and Dying Process; Issues of Policy, Ethics, and Law; and Bereavement.

Other key findings reported in the Oncology Nursing Forum included:

Compared to content regarding non-drug interventions for pain (44 pages), there was far less (25 pages) for pharmacologic interventions for pain.

Quality-of-life issues and role/needs of family caregivers received the smallest amount of coverage.

The pharmacology books reviewed were weak and often had outdated or incorrect information regarding pain and symptom management.

Information about sharing bad news or communicating among interdisciplinary health professionals was lacking.

The issues of assisted suicide and euthanasia were discussed in only 17 texts, with four texts devoting only one paragraph to this topic.

Only one text mentioned regulatory barriers to effective pain management.

Overall, 74% of critical end-of-life content was found to be absent from the texts.