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Enhancing Goal-Concordant Care in Oncology: Development and Impact of an Institutional Communication Skills Training
Heather N Bitar1, Andrew T Leitner1, William Dale1
1Department of Supportive Care Medicine, City of Hope, Duarte, CA.
Purpose:
As part of the Alliance of Dedicated Cancer Centers' Improving Goal-Concordant Care (IGCC) initiative, we developed and delivered virtual communication skills training (CST) series to improve the quality of serious illness communication and goal-concordant care (GCC) targeting hematologists, medical oncologists, and advanced practice providers (APPs).
Methods:
The CST included two live-virtual workshops: (1) communication frameworks for GCC and difficult conversations and (2) advance care planning (ACP), including documentation and billing. Workshops incorporated didactics, interactive case discussions, role-play exercises, and training in electronic health record documentation and ACP billing. Clinician confidence and feedback were assessed via postworkshop evaluations. Patient-reported experience was assessed using the heard and understood (HAU) scale from Press Ganey surveys. Pre-/post-training changes in top-box HAU scores were analyzed via paired t-tests and mixed-effects modeling.
Results:
Ninety-three clinicians completed the training evaluation for workshop 1, and 98 completed the evaluation for workshop 2. Over 75% of participants rated content as good or outstanding, with strong gains in self-reported confidence in using ACP tools, Physicians Orders for Life-Sustaining Treatment (POLST) forms, billing codes, and the SPIKES protocol to deliver difficult news. Compared with pretraining scores, physicians demonstrated significant improvement in overall patient-reported HAU scores (79.46 v 83.77, P = .002), particularly for patient perception of being HAU (78.04 v 83.27, P = .012). APPs had higher baseline scores than physicians (90.74 v 78.04, P < .001), with no significant change post-training.
Conclusion:
Our IGCC CST series improved clinician-reported confidence in applying the learned skills and enhanced patient-reported communication quality among physicians, supporting broader implementation of the training program to strengthen serious illness communication in oncology care.
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