A Longitudinal, Palliative Care Educational Pilot in Hematology-Oncology Fellowship Training.

Abstract

Background: Despite guidelines advocating that patients with advanced cancer receive dedicated palliative care (PC) services, many patients lack access. Improved training in PC for hematology-oncologists could help, yet studies have shown deficits in PC knowledge and education. We designed a novel longitudinal, PC continuity rotation for hematology-oncology (H/O) fellows and assessed feasibility, acceptability, value, and impact. Methods: Fellows from a single cancer center in the United States prospectively identified patients with PC needs from their H/O continuity practice and referred them to PC to follow in both clinics. Participation was tracked for feasibility. Pre- and post-rotation surveys on PC knowledge and skill confidence were compared using generalized linear models. Fellows were also surveyed on acceptability and participated in exit interviews. Results: From 2018 to 2023, 19 fellows participated, each referring 2-4 continuity patients to PC. Fifty-one patients had a total of 132 PC visits, and fellows participated in 125 (95%). From pre- to post-rotation, there was improvement in fellows' PC knowledge (mean 6.44/10 to 7.92, p < 0.01). Ratings of skill confidence improved in 14 of 26 items (p < 0.05), including titrating opioids, estimating prognosis, and working with an interdisciplinary team. Seventeen fellows completed the post-assessment, and 100% agreed it changed clinical practice. In exit interviews, fellows reflected on how meaningful the rotation was. Conclusion: Our novel, longitudinal, PC continuity rotation for H/O fellows was highly feasible, acceptable, and meaningful. The rotation improved PC skills and changed clinical practice, serving as a national model for integrating PC education into H/O fellowship.