National survey of oncology fellows on palliative care education

Abstract

9541 Background: Palliative care (PC) is recognized as an integral part of the practice of oncology, yet many oncologists report inadequate training in critical PC domains, such as symptom management, psychosocial care and communication skills. We sought to assess the quantity and quality of PC education within oncology fellowships. Methods: Second year fellows enrolled in US oncology fellowships were invited to complete a 104 item survey that was modified from a national telephone survey of medical students and residents. Topics included: 1) quality and quantity of teaching and education, 2) observation and feedback, 3) knowledge, 4) attitudes and preparation. Items were designed to allow comparison between PC and non-PC topics. To reduce Type I errors from multiple testing, an alpha level of 0.01 was considered statistically significant. Results : Of 402 eligible fellows, 63.5% responded (n=254). Respondents were: 52% male, 62% White, 27% Asian and 64% US medical school graduates. One-quarter (26%) had completed a PC rotation and 68% reported exposure to palliative care during their fellowship. On a 5-point Likert Scale, fellows rated teaching on PC less highly than the overall quality of fellowship teaching (3.0 v 3.7; p<0.001). Fellows rated attending oncologists less favorably in performing PC skills compared to other oncology skills: managing pain in the terminally ill versus managing spinal cord compression (3.9 v. 4.5; p < 0.001); discussing the decision to stop chemotherapy versus discussing chemotherapy side effects (3.8 v. 4.2; p < 0.001). Fellows were less likely to be observed (81% v 93%; p =0.005) or receive feedback (80 v 93%; p= 0.02) on end-of-life (EOL) discussions than bone marrow biopsies. Many fellows reported not receiving explicit education on PC topics: managing depression at the EOL (68%), opioid rotation (67%), telling a patient she is dying (42%) and hospice referral (37%). Fellows who completed a PC rotation were more likely to report explicit teaching on opioid rotation (p =0.005) and hospice referral (p = 0.002). Conclusions: Our study reveals opportunities for improving the PC training of oncology fellows. No significant financial relationships to disclose.