Palliative care training in surgical oncology and hepatobiliary fellowships: a national survey of the fellows.
BACKGROUND
Surgical oncologists (SO) and hepatobiliary (HPB) surgeons frequently care for patients with advanced diseases near the end of life, yet little is known about their training, comfort, and readiness in the provision of palliative care. This study sought to assess the quality, adequacy, and extent of palliative care training and the readiness of SO and HPB fellows in delivering palliative care.


METHODS
A self-administered survey was distributed to all fellows enrolled in Society of Surgical Oncology (SSO) and HPB fellowships during the 2013-2014 academic year. The survey assessed attitudes, training, experience, and readiness of fellows in caring for patients at the end of life. Descriptive analysis was performed, and Chi square, Student's t test, and the Mann-Whitney U test were used to compare mean or median values as appropriate.


RESULTS
The response rate was 47.2 %, and 50.9 % of the fellows reported exposure to a palliative care specialty service during their fellowship. Of the study participants, 75 % observed their faculty discussing the side effects of surgery compared with 54 % who observed faculty communication with patients regarding end-of-life goals (p < 0.01). On the other hand, 40 % of the fellows were never observed by faculty discussing symptoms management, goals of care, or hospice referral with patients, and 56.7 % never received feedback on their palliative skills.


CONCLUSIONS
The fellows rated the quality of their palliative care education as poor compared with other aspects of their fellowship training, implying the lack and need of palliative care teaching. Surgical oncology and HPB fellows and ultimately patients may benefit from increased clinical and didactic palliative care training.
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Albert
A
Amini
John T
JT
Miura
Greg
G
Larrieux
Susan
S
Tsai
Kiran K
KK
Turaga
Kathleen K
KK
Christians
Karen J
KJ
Brasel
T
T
Clark Gamblin
David E
DE
Weissman
Ann B
AB
Nattinger
Fabian M
FM
Johnston
D000328:Adult; D001291:Attitude of Health Personnel; D001660:Biliary Tract Diseases; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008107:Liver Diseases; D008297:Male; D008495:Medical Oncology / Q000193:education*; D010166:Palliative Care; D011795:Surveys and Questionnaires