April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: Cancer Clinical Trial Communication Skills Among Hematology-Oncology Fellows: A Qualitative Exploration of Educational Needs
Background: Cancer clinical trials (CCTs) are essential for advancing treatment, yet only 5-8% of people with cancer participate, with lower rates among underserved groups.1 One reason for low enrollment is oncologists not discussing CCTs with patients, and when they do, not using effective patient-centered communication. Teaching CCT communication skills to oncologists during training may increase the frequency and quality of patient-oncologist communication about CCTs, contributing to higher participation rates. However, little is known about interest in or feasibility of CCT communication skills training in Hematology-Oncology (Hem-Onc) graduate medical education (GME) fellowships.
Objective: Our objective was to investigate how fellowship programs are approaching CCT communication training by interviewing Hem-Onc program directors (PDs). We aimed to (1) describe current practices, needs, and preferences for fellows’ CCT communication training and (2) examine the preferred approaches for, and acceptability and feasibility of, implementing a recently piloted 3-hour CCT communication skills workshop.
Methods: We interviewed PDs (n=12) from Hem-Onc fellowship programs across the United States. Participants were recruited via the American Society of Clinical Oncology (ASCO) program directors’ association, a public list of Accreditation Council for Graduate Medical Education (ACGME) Hematology-Oncology programs, and co-authors’ professional networks. Interviews were recorded and professionally transcribed, followed by a thematic analysis of the data. Participants were compensated with a $50 gift card.
Results: Themes are contextualized by PDs’ perceptions of how their programs educate fellows about CCT knowledge and communication. PDs discussed (1) current training approaches, (2) fellows’ and programs’ strengths and weaknesses, (3) addressing barriers and weaknesses, (4) training challenges, and (5) strategies for developing and implementing training. First, PDs described their current curriculum as combining didactic and experiential approaches where “the majority of learning is hands-on” and prioritizes clinical research fundamentals (e.g., CCT design, research methods, biostatistics). However, PDs acknowledged this CCT-related curriculum is typically “not mandatory.” Second, PDs characterized fellows as skilled in basic clinical investigation and communicating CCT fundamentals to patients but less proficient in understanding and “explaining the nuances” of CCTs. Weaknesses were underscored by perceived program deficiencies, including lack of a comprehensive CCT curriculum, limited practice opportunities, and inadequate focus on patient diversity. Third, PDs stressed strategies programs are undertaking to address weaknesses including integrating equity and diversity into the curriculum, promoting institutional resources, and encouraging patient-centered communication (e.g., longer appointments, visual aids). Fourth, PDs acknowledged CCT training challenges included fellows’ limited availability (“they are overwhelmed already”), lack of “formal training in clinical trial communication,” and variability between clinics and supervising mentors. Finally, when asked about implementing a CCT communication workshop, PDs strongly preferred in-person or synchronous virtual sessions that integrate experiential learning techniques like role play and simulated patients. They further emphasized the value and utility of a universal yet locally adaptable curriculum, so they don’t have to “reinvent the wheel.”
Implications: By highlighting programs’ current training practices, needs, challenges, and preferences, this study is an important step towards implementing and scaling communication skills training in GME programs, with the goal of increasing CCT participation among diverse cancer patient populations.
Objective: Our objective was to investigate how fellowship programs are approaching CCT communication training by interviewing Hem-Onc program directors (PDs). We aimed to (1) describe current practices, needs, and preferences for fellows’ CCT communication training and (2) examine the preferred approaches for, and acceptability and feasibility of, implementing a recently piloted 3-hour CCT communication skills workshop.
Methods: We interviewed PDs (n=12) from Hem-Onc fellowship programs across the United States. Participants were recruited via the American Society of Clinical Oncology (ASCO) program directors’ association, a public list of Accreditation Council for Graduate Medical Education (ACGME) Hematology-Oncology programs, and co-authors’ professional networks. Interviews were recorded and professionally transcribed, followed by a thematic analysis of the data. Participants were compensated with a $50 gift card.
Results: Themes are contextualized by PDs’ perceptions of how their programs educate fellows about CCT knowledge and communication. PDs discussed (1) current training approaches, (2) fellows’ and programs’ strengths and weaknesses, (3) addressing barriers and weaknesses, (4) training challenges, and (5) strategies for developing and implementing training. First, PDs described their current curriculum as combining didactic and experiential approaches where “the majority of learning is hands-on” and prioritizes clinical research fundamentals (e.g., CCT design, research methods, biostatistics). However, PDs acknowledged this CCT-related curriculum is typically “not mandatory.” Second, PDs characterized fellows as skilled in basic clinical investigation and communicating CCT fundamentals to patients but less proficient in understanding and “explaining the nuances” of CCTs. Weaknesses were underscored by perceived program deficiencies, including lack of a comprehensive CCT curriculum, limited practice opportunities, and inadequate focus on patient diversity. Third, PDs stressed strategies programs are undertaking to address weaknesses including integrating equity and diversity into the curriculum, promoting institutional resources, and encouraging patient-centered communication (e.g., longer appointments, visual aids). Fourth, PDs acknowledged CCT training challenges included fellows’ limited availability (“they are overwhelmed already”), lack of “formal training in clinical trial communication,” and variability between clinics and supervising mentors. Finally, when asked about implementing a CCT communication workshop, PDs strongly preferred in-person or synchronous virtual sessions that integrate experiential learning techniques like role play and simulated patients. They further emphasized the value and utility of a universal yet locally adaptable curriculum, so they don’t have to “reinvent the wheel.”
Implications: By highlighting programs’ current training practices, needs, challenges, and preferences, this study is an important step towards implementing and scaling communication skills training in GME programs, with the goal of increasing CCT participation among diverse cancer patient populations.