Palliative Care Education in Cardiovascular Disease Fellowships: A National Survey of Program Directors

Abstract

Palliative care (PC) is an essential component of high-quality cardiovascular disease (CVD) care. However, little is known about the current state of PC education in CVD training including attitudes towards integration in training and implementation among program leadership. We developed a nationwide, cross-sectional survey querying educational approaches, perspectives, and barriers to PC education in general CVD fellowship training. The survey was distributed to 392 members of the American College of Cardiology Program Director (PD) listserv representing 290 general CVD fellowships between 1/2023 and 4/2023. We performed descriptive and chi square analyses of survey data. Fifty-six program representatives completed the survey (response rate = 19.3%). Respondents identified as current PDs (89%), associate PDs (8.9%), and former PDs (1.8%), representing a diverse range of program sizes, types, and regions of the country. Respondents reported use of informal bedside teaching (88%), formal didactics (59%), online or self-paced modules (13%), in-person simulation (11%), and clinical rotations (16%) to teach PC content. Most programs covered PC topics at least annually, although there was variability by topic. We found no associations between program demographics and type or frequency of PC education. Most respondents reported dissatisfaction with the quantity (62%) or quality (59%) of PC education provided. Barriers to PC education included an overabundance of other content to cover (36%) and perceived lack of fellow (20%) or faculty (18%) interest. Comments demonstrated the importance of PC education in fellowship, a lack of a requirement to provide PC education, difficulty covering all topics, and suggestions for how PC skills should be taught. In a national survey of CVD educational leadership on approaches to PC education in CVD training, respondents highlighted both challenges to implementation of formal PC curricula in cardiology training and opportunities for comprehensive PC education.