Patient-Centered Communication Training among Radiation Oncology Residents

Purpose/Objective(s) Radiation oncologists frequently 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, education and specific training on palliative care including patient-centered communication skills for radiation oncology residents is lacking. The primary objective of this study was to assess radiation oncology resident-identified needs and preparedness in patient-centered serious illness communication to guide the objectives and development of a practice-based skills course. Materials/Methods A needs-based assessment was performed among radiation oncology residents at a single academic medical center. A cross-sectional survey and semi-structured interviews were performed. Data from these metrics were reviewed independently by the authors who then collectively indexed, charted, and analyzed the data. The course was then developed by a multidisciplinary team of specialists in radiation oncology, palliative medicine, and patient communication. The virtual course consisted of didactic teaching, two half-day interactive practice sessions with standardized patient encounters and feedback, and pre- and post-course assessments of measurable communication skills. Results 14/14 (100%) responses were available for evaluation. Using a five-point Likert scale, 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%). PGY-5 residents generally felt more prepared (Likert 4/5) compared to less experienced residents (Likert 3/5). The interview data supported and expanded on the quantitative data, highlighting both the varied and paucity of communication training prior to residency and the need for radiation oncology specific instruction. When asked how they might improve these skills some residents remarked, "practicing conversations," "observing others," and "learning best practices for these situations." The course development was curated by these results. Conclusion Consistent with a national survey of radiation oncology residency program directors, the institution-specific needs assessment study established a convincing need at the residency program level for a practice-based patient-centered communication skills training program for radiation oncology residents. This pre-survey data provided information that was used to guide its objectives, development, and assessment. We hope this future course can serve as an adaptable model that can be instituted among radiation oncology residency programs.