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.