Prior reviews of small numbers of medical textbooks suggest that end-of-life
care is not well covered in textbooks. No broad study of end-of-life care
content analysis has been performed on textbooks across a wide range of medical,
pediatric, psychiatric, and surgical specialties.
To determine the quantity and rate the adequacy of information on end-of-life
care in textbooks from multiple medical disciplines.
Design and Sources
A 1998 review of 50 top-selling textbooks from multiple specialties
(cardiology, emergency medicine, family and primary care medicine, geriatrics,
infectious disease and acquired immunodeficiency syndrome [AIDS], internal
medicine, neurology, oncology and hematology, pediatrics, psychiatry, pulmonary
medicine, and surgery) for the presence and adequacy of content in 13 end-of-life
Main Outcome Measures
Chapters on diseases commonly causing death and those devoted to end-of-life
care were identified, read, rated, and compared by textbook specialty, chapter,
and domain for the presence of helpful information in the 13 domains. Content
for each domain was rated as absent, minimally present, or helpful. Textbook
indexes were analyzed for the number of pages relevant to end-of-life care.
Overall, helpful information was provided in 24.1% (range, 8.7%-44.2%)
of the expected end-of-life content domains; in 19.1% (range, 6.2%-38.5%),
expected content received minimal attention; and in 56.9% (range, 23.1%-77.9%),
expected content was absent. As a group, the textbooks with the highest percentages
of absent content were in surgery (71.8%), infectious diseases and AIDS (70%),
and oncology and hematology (61.9%). Textbooks with the highest percentage
of helpful end-of-life care content were in family medicine (34.4%), geriatrics
(34.4%), and psychiatry (29.6%). In internal medicine textbooks, the content
domains with the greatest amount of helpful information were epidemiology
and natural history. Content domains covered least well were social, spiritual,
ethical, and family issues, as well as physician after-death responsibilities.
On average, textbook indexes cited 2% of their total pages as pertinent to
Top-selling textbooks generally offered little helpful information on
caring for patients at the end of life. Most disease-oriented chapters had
no or minimal end-of-life care content. Specialty textbooks with information
about particular diseases often did not contain helpful information on caring
for patients dying from those diseases.