Skip to main content

Advertisement

SpringerLink
Log in

Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of the Fellows

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

Abstract

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.

Conclusion

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.

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

Similar content being viewed by others

References

  1. Smith BD, Smith GL, Hurria A, Hortobagyi GN, Buchholz TA. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–65.

    Article  PubMed  Google Scholar 

  2. Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin. 2012;62:10–29.

    Article  PubMed  Google Scholar 

  3. Jemal A, Siegel R, Xu J, Ward E. Cancer statistics, 2010. CA Cancer J Clin. 2010;60:277–300.

    Article  PubMed  Google Scholar 

  4. Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of functional decline at the end of life. JAMA. 2003;289:2387–92.

    Article  PubMed  Google Scholar 

  5. WHO Definition of Palliative Care. 2014. At http://www.who.int/cancer/palliative/definition/en/. Accessed 20 Feb 2014.

  6. Bakitas M, Lyons KD, Hegel MT, et al. Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009;302:741–9.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  7. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363:733–42.

    Article  CAS  PubMed  Google Scholar 

  8. Dunn GP, Martensen R, Weissman D. Surgical palliative care: a resident’s guide. Essex, CT: American College of Surgeons, 2009.

    Google Scholar 

  9. Weissman DE, Block SD. ACGME requirements for end-of-life training in selected residency and fellowship programs: a status report. Acad Med. 2002;77:299–304.

    Article  PubMed  Google Scholar 

  10. Americas Hepato-Pancreato-Billiary Association (AHPBA). AHPBA Curriculum. www.AHBPA.org. Accessed 02 Nov 2013.

  11. Buss MK, Lessen DS, Sullivan AM, Von Roenn J, Arnold RM, Block SD. A study of oncology fellows’ training in end-of-life care. J Support Oncol. 2007;5:237–42.

    PubMed  Google Scholar 

  12. Sullivan AM, Lakoma MD, Block SD. The status of medical education in end-of-life care: a national report. J Gen Intern Med. 2003;18:685–95.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Survey Monkey. 2014. At http://www.surverymonkey.com. Accessed 01 Dec 2013.

  14. Buchman TG, Cassell J, Ray SE, Wax ML. Who should manage the dying patient? Rescue, shame, and the surgical ICU dilemma. J Am Coll Surg. 2002;194:665–73.

    Article  PubMed  Google Scholar 

  15. Cassell J, Buchman TG, Streat S, Stewart RM, Buchman TG. Surgeons, intensivists, and the covenant of care: administrative models and values affecting care at the end of life. Crit Care Med. 2003;31:1263–70.

    Article  PubMed  Google Scholar 

  16. Schwarze ML, Bradley CT, Brasel KJ. Surgical “buy-in”: the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy. Crit Care Med. 2010;38:843–8.

    Article  PubMed Central  PubMed  Google Scholar 

  17. Holley JL, Carmody SS, Moss AH, et al. The need for end-of-life care training in nephrology: national survey results of nephrology fellows. Am J Kidney Dis. 2003;42:813–20.

    Article  PubMed  Google Scholar 

  18. Lesnock JL, Arnold RM, Meyn LA, et al. Palliative care education in gynecologic oncology: a survey of the fellows. Gynecol Oncol. 2013;130:431–5.

    Article  CAS  PubMed  Google Scholar 

  19. Pan CX, Carmody S, Leipzig RM, et al. There is hope for the future: national survey results reveal that geriatric medicine fellows are well-educated in end-of-life care. J Am Geriatr Soc. 2005;53:705–10.

    Article  PubMed  Google Scholar 

  20. Bradley EH, Cramer LD, Bogardus ST Jr, Kasl SV, Johnson-Hurzeler R, Horwitz SM. Physicians’ ratings of their knowledge, attitudes, and end-of-life-care practices. Acad Med. 2002;77:305–11.

    Article  PubMed  Google Scholar 

  21. Weissman DE, Ambuel B, von Gunten CF, et al. Outcomes from a national multispecialty palliative care curriculum development project. J Palliat Med. 2007;10:408–19.

    Article  PubMed  Google Scholar 

  22. von Gunten CF. Interventions to manage symptoms at the end of life. J Palliat Med. 2005;8(Suppl 1):S88–94.

    Google Scholar 

  23. Weissman DE, Quill TE, Block SD. Missed opportunities in medical student education. J Palliat Med. 2010;13:489–90.

    Article  PubMed  Google Scholar 

  24. Schaefer KG, Chittenden EH, Sullivan AM, et al. Raising the bar for the care of seriously ill patients: results of a national survey to define essential palliative care competencies for medical students and residents. Acad Med. 2014;89:1024–31.

    Article  PubMed  Google Scholar 

  25. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296:1094–102.

    Article  CAS  PubMed  Google Scholar 

  26. Hodges B, Regehr G, Martin D. Difficulties in recognizing one’s own incompetence: novice physicians who are unskilled and unaware of it. Acad Med. 2001;76:S87–9.

    Article  CAS  PubMed  Google Scholar 

  27. Cummings SM, Savitz LA, Konrad TR. Reported response rates to mailed physician questionnaires. Health Serv Res. 2001;35:1347–55.

    PubMed Central  CAS  PubMed  Google Scholar 

  28. Nulty DD. The adequacy of response rates to online and paper surveys: what can be done? Assess Eval Higher Ed. 2008;33:301–14.

    Article  Google Scholar 

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

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgment

The authors acknowledge the Foundation of Surgical Fellowships for its support.

Disclosure

No relevant financial disclosures.

Author information

Authors and Affiliations

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

    Albert Amini MD, John T. Miura MD, Greg Larrieux MD, Susan Tsai MD, MHS, Kiran K. Turaga MD, MPH, Kathleen K. Christians MD, T. Clark Gamblin MD, MS & Fabian M. Johnston MD, MHS

  2. Division of Trauma and Acute Care, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA

    Karen J. Brasel MD, MPH

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

    David E. Weissman MD

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

    Ann B. Nattinger

Authors
  1. Albert Amini MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. John T. Miura MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Greg Larrieux MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Susan Tsai MD, MHS
    View author publications

    You can also search for this author in PubMed Google Scholar

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

    You can also search for this author in PubMed Google Scholar

  6. Kathleen K. Christians MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Karen J. Brasel MD, MPH
    View author publications

    You can also search for this author in PubMed Google Scholar

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

    You can also search for this author in PubMed Google Scholar

  9. David E. Weissman MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Ann B. Nattinger
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. 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

Amini, A., Miura, J.T., Larrieux, G. et al. Palliative Care Training in Surgical Oncology and Hepatobiliary Fellowships: A National Survey of the Fellows. Ann Surg Oncol 22, 1761–1767 (2015). https://doi.org/10.1245/s10434-014-4226-0

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-014-4226-0

Keywords

Search

Navigation