Advancing palliative medicine training in adolescent and young adult care: a needs assessment study

Adolescents and young adults (AYAs), defined as individuals aged 15-39 years, face unique medical, psychosocial, and existential challenges when living with life-limiting illness. Despite evidence supporting early palliative care integration, Canadian adult palliative care curricula lack formalized AYA-specific competencies. Healthcare providers consistently report insufficient preparation in this area.

A descriptive cross-sectional needs assessment survey was administered nationally to physicians who completed Canadian adult palliative care residency training between 2019 and 2024. A multidisciplinary steering committee of experts in AYA palliative care and medical education, alongside a patient partner, guided the development of the bilingual 25-item questionnaire guided by an established framework for medical education survey design. The questionnaire assessed clinical exposure, self-rated knowledge across 20 competency areas, comfort levels across 21 competency areas, training needs and barriers, and preferred learning formats. Responses were anonymous. Descriptive statistics were used for analysis.

Of 71 responses received, 55 met eligibility criteria for analysis (response rate 35%, eligibility rate 77%). Only 31% of participants received AYA-specific training during residency. Most participants (82%) reported low comfort when caring for the youngest AYA age group (15-18 years). The greatest knowledge gaps were in pediatric-to-adult care transitions (69%), sexual health and fertility concerns (62%), and social support navigation (39%). Top training priorities were AYA developmental and psychosocial factors (75%), grief and bereavement support (65%), and care transitions (60%). The most common training barriers were limited clinical exposure (78%), lack of mentors (65%), and absence of AYA-specific programs (61%).

Our findings revealed substantial gaps in training, knowledge, and comfort levels in providing AYA palliative care among recent graduates from the adult palliative care programs in Canada. This may represent an initial step towards the development of a competency-based AYA-focused residency training curriculum.