Integration of a Mandatory Palliative Care Education Into Hematology-Oncology Fellowship Training in a Comprehensive Cancer Center: A Survey of Hematology Oncology Fellows

Abstract

PURPOSE: The primary aim of this study was to determine the attitudes and beliefs of hematology and medical oncology (HMO) fellows regarding palliative care (PC) after they completed a 4-week mandatory PC rotation. METHODS: The PC rotation included a 4-week standardized curriculum covering all PC domains. HMO fellows were provided educational materials and attended all didactic sessions. All had clinical rotation in an acute PC unit and an outpatient clinic. All HMO fellows from 2004 to 2017 were asked to complete a 32-item survey on oncology trainee perception of PC. RESULTS: Of 105 HMO fellows, 77 (73%) completed the survey. HMO fellows reported that PC rotation improved assessment and management of symptoms (98%); opioid prescription (89%), opioid rotation (78%), and identification of opioid adverse effects (87%); communication with patients and families (91%), including advance care planning discussion (88%) and do-not-resuscitate discussion (88%); and they reported comfort with discussing ethical issues (74%). Participants reported improvement in knowledge of symptom assessment and management (n = 76; 98%) as compared with efficacy in ethics (n = 57 [74%]; P = .0001) and for coping with stress of terminal illness (n = 45 [58%]; P = .0001). The PC rotation educational experience was considered either far better or better (53%) or the same (45%) as other oncology rotations. Most respondents (98%) would recommend PC rotations to other HMO fellows, and 95% felt rotation should be mandatory. CONCLUSION: HMO fellows reported PC rotation improved their attitudes and knowledge in all PC domains. PC rotation was considered better than other oncology rotations and should be mandatory.

Case for Dual Training in Medical Oncology and Palliative Care

“…Palliative care skills can be taught and learned. 7,11 Repackaging what we teach our fellows is a useful and important venture. More time in teaching palliative care principles recognizes this education as one of the most important and therapeutic tools in cancer medicine.…”

Palliative care education and research at US cancer centers: A national survey

“…[22][23][24] In a recent survey of 77 hematology-oncology fellows who had a mandatory structured 1-month palliative care rotation at MD Anderson Cancer Center, 98% reported that it improved their knowledge of symptom management; 95% felt that this rotation should be mandatory. 24 We previously found that younger oncologists and those who reported more confidence in the delivery of primary palliative care were also were more likely to refer patients to a specialist palliative care team. 25,26 The Accreditation Council for Graduate Medical Education, along with program directors for oncology and palliative care, all have an important role defining the curriculum for oncology trainees.…”

“…Notably, a greater number of NCI‐designated cancer centers reported having mandatory rotations for medical oncology fellows since 2009, although approximately half of them still had no such rotations. Such clinical rotations not only enhance the primary palliative care competencies among oncologists, but also their comfort level with palliative care teams and recognition of when a palliative care referral is indicated 22‐24 . In a recent survey of 77 hematology–oncology fellows who had a mandatory structured 1‐month palliative care rotation at MD Anderson Cancer Center, 98% reported that it improved their knowledge of symptom management; 95% felt that this rotation should be mandatory 24 .…”

“…Such clinical rotations not only enhance the primary palliative care competencies among oncologists, but also their comfort level with palliative care teams and recognition of when a palliative care referral is indicated 22‐24 . In a recent survey of 77 hematology–oncology fellows who had a mandatory structured 1‐month palliative care rotation at MD Anderson Cancer Center, 98% reported that it improved their knowledge of symptom management; 95% felt that this rotation should be mandatory 24 . We previously found that younger oncologists and those who reported more confidence in the delivery of primary palliative care were also were more likely to refer patients to a specialist palliative care team 25,26 .…”

End-of-life and goals of care discussions with cancer patients in the coronavirus pandemic

“…Conversations at the EOL are often bungled and not done well (Marcus et al, 2006;Mott, 2013, 2014;Mott and Adams, 2019). While many training programs include palliative care modules, there is much variability across different programs as well as different levels of awareness and beliefs among trainees in different specialties (Wong et al, 2016;Reddy et al, 2019). Patients' and families' perceptions of what palliative care means and its larger concept of GOC and EOL discussions are additional hurdles (Lo et al, 1999;Singer et al, 1999;Heyland, 2006).…”