Integration of palliative care into oncology: A curriculum development project.

Abstract

202 Background: Program Directors of Oncology Fellowships cite lack of adequate faculty to teach communication skills, prognostication and symptom management to oncology fellows as a barrier to ensuring oncologists integrate palliative care into their own practice. We partnered with ASCO and its Training Program directors to develop, evaluate and disseminate a PC curriculum using an innovative format. Methods: All of the fellows in a program were randomized as a single group to one of 3 cohorts: digital education, digital education plus a 4-week palliative care rotation or delayed digital education (control). In the intervention, each fellow received 2 MCQs (on their phones or other device) focused on a particular teaching point, every other day. If answered incorrectly, focused education material was forwarded to the learner and the testing point was retested at a later date. Fellows in cohort 2 also participated in a clinical rotation at an ACGME approved PC program. Cohort 3 received the same training as cohort one, but beginning fellowship year 2, as a delayed control. Fellows’ PC knowledge was assessed during the in-training exam pre- and post-intervention. Opioid prescribing behavior was tracked after graduation and compared with a control group( group 4). Results: 283 fellows from 71 programs were quasi-randomized. The average ITE score of PC MCQs ranged from 70-73% correct across all groups and all years, for pre- and post-test scores. All fellows randomized to the PC rotation, completed it. Prescribing data was based on NPI numbers and available for all providers. 72% of cohort 1 prescribed opioids appropriately, 57% cohort 2, 72% cohort 3, 46% in a group 4 (1 vs 4, p=.0008; 2 vs 4, p=.2231; 3 vs l, p=.0011). Conclusions: Spaced education via a hand held device is acceptable, efficient and cost-effective. All groups showed acceptable knowledge on the in-training examination. Yet, opioid prescribing behavior improved as a result of the education intervention. The favorable impact on opioid-prescribing behavior was extinguished by the PC rotation, raising the question about the role of a PC clinical rotation.

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

“…This may be a result of the complex nature of cancer pain and opioid management, and may need longer than a 4-week rotation to feel confident with opioid pain management. In contrast, Von Gunten et al 25 randomly assigned HMO fellows to one of the three cohorts: digital education, digital education plus a 4-week clinical rotation to PC, and delayed digital education by 1 year as a delayed control. They reported a 73% to 75% improvement in PC domains and practice behavior change of opioid prescription after completing the fellowship.…”

“…However, opioid-prescribing behavior was significantly better for the first cohort of digital education, but there was a deterioration in opioid-prescribing behavior in the digital education plus a 4-week clinical rotation to PC cohort. 25 This may be the result of fellows on rotation being able to observe complex opioid regimens and needing more time to master details of opioid physiology, dose titration, metabolism, and rotations. In addition, with changing perception and regulations surrounding opioid prescription amid an epidemic, oncologists may feel less comfortable prescribing opioids despite reporting improved perception in knowledge.…”