Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Palliative Care

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

Authors: 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, Wendy L. Peltier, MD, David E. Weissman, MD, Ann B. Nattinger, MD, MPH, Fabian M. Johnston, MD, MHS

Published in: Annals of Surgical Oncology | Special Issue 3/2015

Login to get access

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.
Literature
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.PubMedCrossRef
3.
Easson AM, et al. Clinical research for surgeons in palliative care: challenges and opportunities. J Am Coll Surg. 2003;196(1):141–51.PubMedCrossRef
4.
5.
Morrison RS, et al. The growth of palliative care programs in United States hospitals. J Palliat Med. 2005;8(6):1127–34.PubMedCrossRef
6.
7.
Levy MH, et al. NCCN clinical practice guidelines in oncology: palliative care. J Natl Compr Canc Netw. 2009;7(4):436–73.PubMed
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.PubMedCrossRef
10.
Dunn GP. Surgical palliative care: recent trends and developments. Anesthesiol Clin. 2012;30(1):13–28.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
13.
Quill TE, Abernethy AP. Generalist plus specialist palliative care: creating a more sustainable model. N Engl J Med. 2013;368(13):1173–5.PubMedCrossRef
14.
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.PubMedCrossRef
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.PubMedCrossRef
17.
Easson AM, Crosby JA, Librach SL. Discussion of death and dying in surgical textbooks. Am J Surg. 2001;182(1):34–9.PubMedCrossRef
18.
Weissman DE, et al. Outcomes from a national multispecialty palliative care curriculum development project. J Palliat Med. 2007;10(2):408–19.PubMedCrossRef
19.
20.
Teno JM, et al. Family perspectives on end-of-life care at the last place of care. JAMA. 2004;291(1):88–93.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
23.
Hancock K, et al. Discrepant perceptions about end-of-life communication: a systematic review. J Pain Symptom Manage. 2007;34(2):190–200.PubMedCrossRef
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.PubMedCrossRef
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
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.PubMedCrossRef
27.
Ford S, Fallowfield L, Lewis S. Doctor-patient interactions in oncology. Soc Sci Med. 1996;42(11):1511–9.PubMedCrossRef
28.
Tulsky JA, et al. Opening the black box: how do physicians communicate about advance directives? Ann Intern Med. 1998;129(6):441–9.PubMedCrossRef
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.PubMedCrossRef
30.
31.
Von Roenn JH, von Gunten C. The care people need and the education of physicians. J Clin Oncol. 2011;29(36):4742–3.CrossRef
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.PubMedCrossRef
33.
34.
35.
36.
37.
38.
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.PubMedCrossRef
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.PubMedCrossRef
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.PubMedCrossRef
Metadata
Title
Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of Program Directors
Authors
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
Wendy L. Peltier, MD
David E. Weissman, MD
Ann B. Nattinger, MD, MPH
Fabian M. Johnston, MD, MHS
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4805-8

Other articles of this Special Issue 3/2015

Annals of Surgical Oncology 3/2015 Go to the issue

Breast Oncology

Improving the Success Rate of Repeat Sentinel Node Biopsy in Recurrent Breast Cancer

Thoracic Oncology

Oligo-Recurrence of Osteosarcoma Patients: Treatment Strategies for Pulmonary Metastases

Hepatobiliary Tumors

Is Hepatic Resection for Non-colorectal, Non-neuroendocrine Liver Metastases Justified?

Endocrine Tumors

Intraoperative Parathormone Monitoring Mitigates Age-Related Variability in Targeted Parathyroidectomy for Patients with Primary Hyperparathyroidism

Thoracic Oncology

Standardized Uptake Values in the Primary Lesions of Non-Small-Cell Lung Cancer in FDG-PET/CT Can Predict Regional Lymph Node Metastases

Endocrine Tumors

Value of Prophylactic Cervical Thymectomy in Parathyroid Hyperplasia