Publications in Subspecialty Journals on End-of-Life Ethics

Abstract

BACKGROUND: Factors that impede patient adoption of advance directives and inhibit physician-patient discussions about end-of-life issues remain incompletely defined. Determination of publication rates of articles on end-of-life ethics in different subspecialty journals may provide insight into physicians' reluctance to promote advance directives for their patients, which appears to vary between subspecialty fields. OBJECTIVE: To determine publication rates of items on end-of-life issues and other ethics topics. METHODS: We surveyed core journals from 1976 to 1995 in cardiology (n = 5), critical care medicine (n = 1), nephrology (n = 4), oncology (n = 7), and pulmonary medicine (n = 2). RESULTS: Critical care medicine (50.4%; 95% confidence interval [CI], 45.0%-55.8%) and pulmonary medicine (27.6%; 95% CI, 22.7%-32.5%) journals published considerably more articles on end-of-life issues than journals in cardiology (4.1%; 95% CI, 0.8%-7.4%), nephrology (11.0%; 95% CI, 7.9%-14.1%), or oncology (6.9%; 95% CI, 1.5%-12.3%). Oncology (30.7%; 95% CI, 25.3%-36.1%), critical care medicine (29.6%; 95% CI, 24.2%-35.0%), and pulmonary medicine (21.5%; 95% CI, 16.6%-26.4%) journals published more items pertaining to all ethics-related topics compared with cardiology (11.0%; 95% CI, 7.3%-14.7%) or nephrology (7.3%; 95% CI, 4.2%-10.4%) journals. Oncology journal ethics articles most often pertained to informed consent or research issues. CONCLUSIONS: Different internal medicine subspecialty fields demonstrate markedly different patterns of publishing items on topics pertaining to end-of-life issues.