Dupuis Megan M, Walsh Katherine J, Agarwal Rajiv
Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
Vanderbilt-Ingram Cancer Center, Nashville, TN.
JCO Oncol Pract. 2025 Jul 29:OP2500104. doi: 10.1200/OP-25-00104.
ASCO strongly endorses the integration of palliative care (PC) to improve outcomes and support patients in their cancer trajectories. Developing core PC skills for trainees is essential, with few Accreditation Council of Graduate Medical Education-approved pilot programs offering combined fellowship training. Our institution's hematology/oncology (Heme/Onc) fellows reported a need for additional education in leading difficult conversations.
We designed and piloted a didactic simulation (sim) session for each fellowship class, led by a faculty member who is dual board-certified in Medical Oncology and Hospice/Palliative Medicine. Sessions included an overview of validated communication tools, suggested oncology-specific language, small-group case-based role-play with faculty supervision and feedback, and concluded with class reflection. Pre- and post-sim surveys assessed self-reported awareness of communication tools and comfort in discussing difficult oncology-specific topics.
In year 1, 16 (76.2%) of 21 fellows completed pre- and post-sim surveys. In year 2, 15 (71.4%) of 21 and 19 (90.4%) of 21 completed pre- and post-sim surveys, respectively. Fellow awareness of communication tools in year 1 increased from 21.9% pre-sim to 79.7% post-sim ( < .05); whereas in year 2, baseline awareness was much higher at 62.6% but still increased to 76.3% post-sim, with notable increase for prognostic discussion tools ( < .05). Comfort increased across multiple domains of difficult conversations in both years 1 and 2 ( < .05). Overall, trainees reported that the sim sessions were useful. Those who participated in the pilot year confirmed application of communication techniques in their clinical practice.
Dedicated and iterative communication teaching in Heme/Onc fellowship is imperative for the development of future generations of oncologists. Our sim session leads to sustained improvement in trainee awareness of communication tools and comfort for leading difficult oncology conversations.
美国临床肿瘤学会（ASCO）大力支持整合姑息治疗（PC）以改善治疗效果，并在患者的癌症治疗过程中为其提供支持。为实习生培养核心PC技能至关重要，而经毕业后医学教育认证委员会批准的提供联合 fellowship 培训的试点项目很少。我们机构的血液学/肿瘤学（血液/肿瘤）研究员表示需要在引导困难对话方面接受更多教育。
我们为每个 fellowship 班级设计并试点了一个理论模拟课程，由一位同时拥有医学肿瘤学和临终关怀/姑息医学双认证的教员授课。课程内容包括对经过验证的沟通工具的概述、建议的肿瘤学特定语言、在教员监督和反馈下基于案例的小组角色扮演，并以班级反思结束。模拟前后的调查评估了自我报告的对沟通工具的认识以及讨论困难的肿瘤学特定主题时的舒适度。
在第1年，21名研究员中有16名（76.2%）完成了模拟前后的调查。在第2年，21名研究员中有15名（71.4%）和19名（90.4%）分别完成了模拟前后的调查。第1年研究员对沟通工具的认识从模拟前的21.9%提高到模拟后的79.7%（P<0.05）；而在第2年，基线认识更高，为62.6%，但仍提高到模拟后的76.3%，预后讨论工具的认识有显著提高（P<0.05）。在第1年和第2年，在困难对话的多个领域舒适度都有所提高（P<0.05）。总体而言，实习生报告说模拟课程很有用。参与试点年的人员确认在临床实践中应用了沟通技巧。
血液/肿瘤 fellowship 中专门的、反复的沟通教学对于培养下一代肿瘤学家至关重要。我们的模拟课程使实习生对沟通工具的认识以及引导困难肿瘤学对话的舒适度持续提高。
