Teaching Communication Skills and Developing Comfort With Difficult Conversations: A Combined Palliative...

ASCO strongly endorses the integration of palliative care (PC) to improve outcomes and support patients in their cancer trajectories. Developing core PC skills for trainees is essential, with few Accreditation Council of Graduate Medical Education-approved pilot programs offering combined fellowship training. Our institution's hematology/oncology (Heme/Onc) fellows reported a need for additional education in leading difficult conversations.

We designed and piloted a didactic simulation (sim) session for each fellowship class, led by a faculty member who is dual board-certified in Medical Oncology and Hospice/Palliative Medicine. Sessions included an overview of validated communication tools, suggested oncology-specific language, small-group case-based role-play with faculty supervision and feedback, and concluded with class reflection. Pre- and post-sim surveys assessed self-reported awareness of communication tools and comfort in discussing difficult oncology-specific topics.

In year 1, 16 (76.2%) of 21 fellows completed pre- and post-sim surveys. In year 2, 15 (71.4%) of 21 and 19 (90.4%) of 21 completed pre- and post-sim surveys, respectively. Fellow awareness of communication tools in year 1 increased from 21.9% pre-sim to 79.7% post-sim (P < .05); whereas in year 2, baseline awareness was much higher at 62.6% but still increased to 76.3% post-sim, with notable increase for prognostic discussion tools (P < .05). Comfort increased across multiple domains of difficult conversations in both years 1 and 2 (P < .05). Overall, trainees reported that the sim sessions were useful. Those who participated in the pilot year confirmed application of communication techniques in their clinical practice.

Dedicated and iterative communication teaching in Heme/Onc fellowship is imperative for the development of future generations of oncologists. Our sim session leads to sustained improvement in trainee awareness of communication tools and comfort for leading difficult oncology conversations.