Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of Program Directors.
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.
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Gregory
G
Larrieux
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Blake I
BI
Wachi
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
John T
JT
Miura
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Kiran K
KK
Turaga
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
Kathleen K
KK
Christians
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA.
T Clark
TC
Gamblin
Medical College of Wisconsin Palliative Care Center, Medical College of Wisconsin, Milwaukee, WI, USA.
Wendy L
WL
Peltier
Medical College of Wisconsin Palliative Care Center, Medical College of Wisconsin, Milwaukee, WI, USA.
David E
DE
Weissman
Department of Medicine, Center for Patient Care and Outcomes Research, Medical College of Wisconsin, Milwaukee, WI, USA.
Ann B
AB
Nattinger
Division of Surgical Oncology, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA. fjohnston@mcw.edu.
Fabian M
FM
Johnston
D001291:Attitude of Health Personnel; D001660:Biliary Tract Diseases; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D006301:Health Services Needs and Demand; D006801:Humans; D007396:Internship and Residency; D008107:Liver Diseases; D008495:Medical Oncology / Q000193:education*; D010166:Palliative Care; D010820:Physicians; D011795:Surveys and Questionnaires