Development of Patient-centered Communication Curriculum for Radiation Oncology Residents

Abstract

<h3>Background</h3> Radiation oncologists often speak with patients who are terminally ill and may be near the end of their life. In fact, up to 63% of patients who died of cancer receive palliative radiation in their last year of life. Despite this, training on palliative care including patient-centered communication skills for radiation oncology residents is lacking. This prompted the development of a serious illness communication curriculum designed for radiation oncology residents. <h3>Methods</h3> Curriculum development followed Kern's Six-step approach. A national survey of radiation oncology residency program directors outlined the lack of communication training and served as a general needs assessment. We performed an institution-specific targeted needs assessment with a cross-sectional survey and semi-structured interviews that reaffirmed a convincing need at the residency program level for a practice-based patient-centered communication skills training program. The objectives, educational strategies, implementation, and evaluation of the curriculum were then developed to target identified deficiencies in resident communication skills. <h3>Results</h3> Data from the targeted needs assessment showed that most residents felt only "somewhat prepared" (Likert 3/5) to discuss important topics such as prognosis (93%), reconciling the seriousness of one's illness (71%), and discontinuing life-sustaining treatments (64%). When asked how they might improve these skills some residents remarked, "practicing conversations," "observing others," and "learning best practices for these situations." A baseline radiation-specific simulated patient encounter was performed at the university's simulation-based learning center. Then, two virtual half-day teaching sessions led by expert faculty facilitators were held. These consisted of didactic learning and mentored resident practice with simulated patients and real time feedback. All teaching and practice were designed for radiation oncology residents. A post-course simulated patient encounter will be performed. Faculty trained in serious illness communication who did not participate in the course will then review the simulated patient encounters and complete a blinded standardized assessment to compare pre- and post-course measurable communication skills. <h3>Discussion</h3> We developed a practice-based patient-centered communication skills curriculum for radiation oncology residents. We expect this work in progress will show measurable improvement of these skills. We plan to integrate this curriculum on a regular, repeating basis for additional skill development and to facilitate durable learning. We hope this course can serve as an adaptable model that can be instituted among radiation oncology residency programs.