Perspective on Death Education the lack of communication between physicians and patients with subse quent adverse effects on patients, it is important to determine what changes have occurred since then Klenow and Young(1987) reviewed the literature on physicians'com- munication with terminally ill cancer patients from the 1960s to the 1980s. They reported a dramatic shift from withholding diagnosis and prognosis to telling patients the truth. However, they also pointed to shortcomings in this literature(e.g, sample selection, response rates that undermine these findings. With the establishment of advance direc tives, the communication issue has become more complex. Findings from the most extensive study of dying in hospitals (involving over 9,000 patients in five major medical centers) indicate that most physi- cians do not know about patients'end-of life wishes, and of those who know, only 15% talk with patients (SUPPORT/ Investigators, 1995) Similarly, a key concern of hospice pioneers was to achieve optimal pain/symptom control in order to allow patients to live their last days nd to die with dignity. Many more pain centers have been established in the United States and abroad since the early days of hospice care, enabling sophisticated pharmaceutical and other means to control pair Yet in the study cited above nearly half of the dying patients in hospitals endured moderate to severe pain, and nearly half spent their last 10 days in intensive care units Medical and nursing education Not surprisingly, there has been inadequate attention to death and dying in medical curricula at all levels. Dickinson is a long-time observer of death education in medical, nursing, and other health-related profes sional schools. In a 1975 survey of U.S. medical schools he found that only half of them offered something more than"a lecture or two"on the subject of death. Moreover, most course offerings listed were electives, d fewer than 10%o offered a full course(Dickinson, 1976). More recent surveys indicated improvement. By the 1990s nearly all medical, nur sing, pharmaceutical, and social work schools offered some education about death and dying, most of it integrated into the basic curricula. In most schools, that consisted of only a few lectures. Full course offerings were improved over the past but still inadequate(13% in schools of med- icine, 15% in nursing). Full-course electives were taken by a fourth of the students. When queried about future plans, half of the medical andthe lack of communication between physicians and patients with subse￾quent adverse effects on patients, it is important to determine what changes have occurred since then. Klenow andYoung (1987) reviewed the literature on physicians’ com￾munication with terminally ill cancer patients from the 1960s to the 1980s. They reported a dramatic shift from withholding diagnosis and prognosis to telling patients the truth. However, they also pointed to shortcomings in this literature (e.g., sample selection, response rates) that undermine these findings.With the establishment of advance direc￾tives, the communication issue has become more complex. Findings from the most extensive study of dying in hospitals (involving over 9,000 patients in five major medical centers) indicate that most physi￾cians do not know about patients’ end-of life wishes, and of those who know, only 15% talk with patients (SUPPORT/Investigators, 1995). Similarly, a key concern of hospice pioneers was to achieve optimal pain/symptom control in order to allow patients to live their last days and to die with dignity. Many more pain centers have been established in the United States and abroad since the early days of hospice care, enabling sophisticated pharmaceutical and other means to control pain. Yet in the study cited above nearly half of the dying patients in hospitals endured moderate to severe pain, and nearly half spent their last 10 days in intensive care units. Medical and Nursing Education Not surprisingly, there has been inadequate attention to death and dying in medical curricula at all levels. Dickinson is a long-time observer of death education in medical, nursing, and other health-related profes￾sional schools. In a 1975 survey of U.S. medical schools he found that only half of them offered something more than ‘‘a lecture or two’’on the subject of death. Moreover, most course offerings listed were electives, and fewer than 10% offered a full course (Dickinson, 1976). More recent surveys indicated improvement. By the 1990s nearly all medical, nur￾sing, pharmaceutical, and social work schools offered some education about death and dying, most of it integrated into the basic curricula. In most schools, that consisted of only a few lectures. Full course offerings were improved over the past but still inadequate (13% in schools of med￾icine, 15% in nursing). Full-course electives were taken by a fourth of the students.When queried about future plans, half of the medical and Perspective on Death Education 293