Skip to main content

Advertisement

SpringerLink
Log in

Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of Program Directors

  • Palliative Care
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Despite previous literature affirming the importance of palliative care training in surgery, there is scarce literature about the readiness of Surgical Oncology and hepatopancreaticobiliary (HPB) fellows to provide such care. We performed the first nationally representative study of surgical fellowship program directors’ assessment of palliative care education. The aim was to capture attitudes about the perception of palliative care and disparity between technical/clinical education and palliative care training.

Methods

A survey originally used to assess surgical oncology and HPB surgery fellows’ training in palliative care, was modified and sent to Program Directors of respective fellowships. The final survey consisted of 22 items and was completed online.

Results

Surveys were completed by 28 fellowship programs (70 % response rate). Only 60 % offered any formal teaching in pain management, delivering bad news or discussion about prognosis. Fifty-eight percent offered formal training in basic communication skills and 43 % training in conducting family conferences. Resources were available, with 100 % of the programs having a palliative care consultation service, 42 % having a faculty member with recognized clinical interest/expertise in palliative care, and 35 % having a faculty member board-certified in Hospice and Palliative Medicine.

Conclusions

Our data shows HPB and surgical oncology fellowship programs are providing insufficient education and assessment in palliative care. This is not due to a shortage of faculty, palliative care resources, or teaching opportunities. Greater focus one valuation and development of strategies for teaching palliative care in surgical fellowships are needed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Cancer Society. Cancer facts and figures. 2014.

  2. Owen R, Jeffrey D. Communication: common challenging scenarios in cancer care. Eur J Cancer. 2008;44(8):1163–8.

    Article  PubMed  Google Scholar 

  3. Easson AM, et al. Clinical research for surgeons in palliative care: challenges and opportunities. J Am Coll Surg. 2003;196(1):141–51.

    Article  PubMed  Google Scholar 

  4. Project TDA. Quality of end-of-life cancer care for Medicare beneficiaries (2010), www.dartmouthatlas.org.

  5. Morrison RS, et al. The growth of palliative care programs in United States hospitals. J Palliat Med. 2005;8(6):1127–34.

    Article  PubMed  Google Scholar 

  6. World Health Organization. WHO definition of palliative care (2014), www.who.int/cancer/palliative/definition/en/.

  7. Levy MH, et al. NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Canc Netw. 2009;7(4):436–73.

    PubMed  Google Scholar 

  8. Medicine Io. Delivering high-quality cancer care: charting a new course for a system in crisis. 2013.

  9. Smith TJ, et al. American Society of Clinical Oncology provisional clinical opinion: the integration of palliative care into standard oncology care. J Clin Oncol. 2012;30(8):880–7.

    Article  PubMed  Google Scholar 

  10. Dunn GP. Surgical palliative care: recent trends and developments. Anesthesiol Clin. 2012;30(1):13–28.

    Article  PubMed  Google Scholar 

  11. Klaristenfeld DD, Harrington DT, Miner TJ. Teaching palliative care and end-of-life issues: a core curriculum for surgical residents. Ann Surg Oncol. 2007;14(6):1801–6.

    Article  PubMed  Google Scholar 

  12. Temel JS, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.

    Article  PubMed  CAS  Google Scholar 

  13. Quill TE, Abernethy AP. Generalist plus specialist palliative care: creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.

    Article  PubMed  CAS  Google Scholar 

  14. Rangachari D, Smith TJ. Integrating palliative care in oncology: the oncologist as a primary palliative care provider. Cancer J. 2013;19(5):373–8.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med. 2011;14(1):17–23.

    Article  PubMed  Google Scholar 

  16. Amini A, et al. Palliative care training in surgical oncology and hepatobiliary fellowships: a national survey of the fellows. Ann Surg Oncol. 2015; 22:1761–7.

    Article  PubMed  Google Scholar 

  17. Easson AM, Crosby JA, Librach SL. Discussion of death and dying in surgical textbooks. Am J Surg. 2001;182(1):34–9.

    Article  PubMed  CAS  Google Scholar 

  18. Weissman DE, et al. Outcomes from a national multispecialty palliative care curriculum development project. J Palliat Med. 2007;10(2):408–19.

    Article  PubMed  Google Scholar 

  19. Survey Monkey (2014), www.surveymonkey.com. Accessed Mar 2014.

  20. Teno JM, et al. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88–93.

    Article  PubMed  CAS  Google Scholar 

  21. Claessens MT, et al. Dying with lung cancer or chronic obstructive pulmonary disease: insights from SUPPORT. Study to understand prognoses and preferences for outcomes and risks of treatments. J Am Geriatr Soc. 2000;48(5 Suppl):S146–53.

    Article  PubMed  CAS  Google Scholar 

  22. McLafferty RB, et al. Surgeon communication behaviors that lead patients to not recommend the surgeon to family members or friends: analysis and impact. Surgery. 2006;140(4):616–22; discussion 622–4.

    Article  PubMed  Google Scholar 

  23. Hancock K, et al. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage. 2007;34(2):190–200.

    Article  PubMed  Google Scholar 

  24. Lautrette A, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med. 2007;356(5):469–78.

    Article  PubMed  CAS  Google Scholar 

  25. Lerman C, et al. Communication between patients with breast cancer and health care providers. Determinants and implications. Cancer. 1993;72(9):2612–20.

    PubMed  CAS  Google Scholar 

  26. Redmann AJ, et al. Use of advance directives for high-risk operations: a national survey of surgeons. Ann Surg, 2012;255(3):418–23.

    Article  PubMed  Google Scholar 

  27. Ford S, Fallowfield L, Lewis S. Doctor-patient interactions in oncology. Soc Sci Med. 1996;42(11):1511–9.

    Article  PubMed  CAS  Google Scholar 

  28. Tulsky JA, et al. Opening the black box: how do physicians communicate about advance directives? Ann Intern Med. 1998;129(6):441–9.

    Article  PubMed  CAS  Google Scholar 

  29. Bernacki RE, Block SD. American College of Physicians High Value Care Task, Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994–2003.

    Article  PubMed  Google Scholar 

  30. Earle CC, et al. Aggressiveness of cancer care near the end of life: is it a quality-of-care issue? J Clin Oncol. 2008;26(23):3860–6.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Von Roenn JH, von Gunten C. The care people need and the education of physicians. J Clin Oncol. 2011;29(36):4742–3.

    Article  Google Scholar 

  32. Arnold L, Shue CK, Jones D. Implementation of geriatric education into the first and second years of a baccalaureate-MD degree program. Acad Med. 2002;77(9):933–4.

    Article  PubMed  Google Scholar 

  33. Surgical palliative care: a resident’s guide (2009), https://www.facs.org/~/media/files/education/palliativecare/surgicalpalliativecareresidents.ashx. Accessed 2014.

  34. Oncotalk: improving oncologists’ communication skills (2014), www.depts.washington.edu/oncotalk.

  35. The Conversation Project (2014), http://theconversationproject.org/.

  36. Vital talk. 2014.

  37. Society of Surgical Oncology Fellows Institute (2014). www.surgonc.org. Accessed Dec 2014.

  38. AHPBA HPB Surgery Fellows Course (2014), www.ahpba.org.

  39. Roth M, et al. An assessment of the current state of palliative care education in pediatric hematology/oncology fellowship training. Pediatr Blood Cancer. 2009;53(4):647–51.

    Article  PubMed  Google Scholar 

  40. Lefkowits C, et al. Needs assessment of palliative care education in gynecologic oncology fellowship: We’re not teaching what we think is most important. Gynecol Oncol. 2014;135(2):255–60.

    Article  PubMed  Google Scholar 

  41. Hebert HD, et al. Are we training our fellows adequately in delivering bad news to patients? A survey of hematology/oncology program directors. J Palliat Med. 2009;12(12):1119–24.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Gregory Larrieux MD, Blake I. Wachi BS, John T. Miura MD, Kiran K. Turaga MD, MPH, Kathleen K. Christians MD, T. Clark Gamblin MD, MS & Fabian M. Johnston MD, MHS

  2. Medical College of Wisconsin Palliative Care Center, Medical College of Wisconsin, Milwaukee, WI, USA

    Wendy L. Peltier MD & David E. Weissman MD

  3. Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA

    Ann B. Nattinger MD, MPH

Authors
  1. Gregory Larrieux MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Blake I. Wachi BS
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John T. Miura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Kiran K. Turaga MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Kathleen K. Christians MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. T. Clark Gamblin MD, MS
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Wendy L. Peltier MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. David E. Weissman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ann B. Nattinger MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Fabian M. Johnston MD, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Fabian M. Johnston MD, MHS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Larrieux, G., Wachi, B.I., Miura, J.T. et al. Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of Program Directors. Ann Surg Oncol 22 (Suppl 3), 1181–1186 (2015). https://doi.org/10.1245/s10434-015-4805-8

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-015-4805-8

Keywords

Search

Navigation