Abstract
Children with cancer experience suffering, particularly at the end of life. Pediatric hematology/oncology (PHO) fellows need dedicated palliative care (PC) training in order to adequately manage this suffering. Our objectives were to understand (1) the PC training needs of Canadian PHO fellows and (2) experiences in providing PC, from the perspectives of fellows and their training program directors (PDs) and to describe (1) our experience in enhancing our institutional PC curriculum and (2) the preliminary evaluation of this curriculum. Electronic surveys were sent to all Canadian PHO fellows and PDs. Fellows participating in our curriculum were also sent post-course surveys. All 9/9 of the PDs and 63% (29/46) of the fellows completed our pre-course surveys. The majority of survey participants agreed that PHO fellows require dedicated PC training. All programs provided some PC education, but 45% of programs offered 3 or fewer hours of training per year. Only 55% (5/9) of the PDs believed that their trainees had adequate PC skills on completion of training. Fellows perceived a range of PC skills to be important but expressed low levels of comfort across these skills. Many fellows had experienced distress as a result of managing PC clinical situations, and many cited a lack of training as contributing to their distress. Despite increasing awareness of the importance of PC education for PHO fellows, this subject does not receive adequate attention in training curricula. The introduction of a Canadian national curriculum may improve the provision of PC training in education programs.
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References
American Cancer Society (2019) Cancer facts and figures 2019. American Cancer Society, Atlanta, Georgia. https://www.cancer.org/content/dam/cancer-org/research/cancer-facts-and-statistics/annual-cancer-facts-and-figures/2019/cancer-facts-and-figures-2019.pdf. Accessed 28 Sept 2021
Wolfe J et al (2000) Symptoms and suffering at the end of life in children with cancer. N Engl J Med 342(5):326–333
Canadian Hospice Palliative Care Association (2013) A model to guide hospice palliative care. Canadian Hospice Palliative Care Association, Ottawa. https://www.chpca.ca/wp-content/uploads/2019/12/norms-of-practice-eng-web.pdf. Accessed 28 Sept 2021
Waldman E, Wolfe J (2013) Palliative care for children with cancer. Nat Rev Clin Oncol 10(2):100–107
Hinds PS et al (2001) End-of-life decision making by adolescents, parents, and healthcare providers in pediatric oncology: research to evidence-based practice guidelines. Cancer Nurs 24(2):122–134 quiz 135-6
Buss MK et al (2011) Hematology/oncology fellows’ training in palliative care: results of a national survey. Cancer 117(18):4304–4311
Roth M et al (2009) An assessment of the current state of palliative care education in pediatric hematology/oncology fellowship training. Pediatr Blood Cancer 53(4):647–651
Davies B et al (2008) Barriers to palliative care for children: perceptions of pediatric health care providers. Pediatrics 121(2):282–288
Jalmsell L et al (2006) Symptoms affecting children with malignancies during the last month of life: a nationwide follow-up. Pediatrics 117(4):1314–1320
Heath JA et al (2010) Symptoms and suffering at the end of life in children with cancer: an Australian perspective. Med J Aust 192(2):71–75
Mack JW et al (2005) Parent and physician perspectives on quality of care at the end of life in children with cancer. J Clin Oncol 23(36):9155–9161
Royal College of Physicians and Surgeons of Canada (2013) Subspecialty training requirements in pediatric hematology/oncology Version 1.0. https://www.royalcollege.ca/rcsite/ibd-search-e?N=10000033+10000034+4294967048&label=Pediatric%20Hematology/Oncology. Accessed 28 Sept 2021
Royal College of Physicians and Surgeons of Canada (2015) Subspecialty training requirements in pediatric palliative medicine Version 1.0. https://www.royalcollege.ca/rcsite/documents/ibd/palliative-medicine-pediatric-str-e. Accessed 28 Sept 2021
Harris PA et al (2019) The REDCap consortium: building an international community of software platform partners. J Biomed Inform 95:103208
Hilden JM et al (2001) Attitudes and practices among pediatric oncologists regarding end-of-life care: results of the 1998 American Society of Clinical Oncology survey. J Clin Oncol 19(1):205–212
Baker JN et al (2007) National survey of pediatric residency program directors and residents regarding education in palliative medicine and end-of-life care. J Palliat Med 10(2):420–429
Lieberman L, Hilliard RI (2006) How well do paediatric residency programmes prepare residents for clinical practice and their future careers? Med Educ 40(6):539–546
Kassam A et al (2014) Parent and clinician preferences for location of end-of-life care: home, hospital or freestanding hospice? Pediatr Blood Cancer 61(5):859–864
Himelstein BP et al (2004) Pediatric palliative care. N Engl J Med 350(17):1752–1762
Bagatell R et al (2002) When children die: a seminar series for pediatric residents. Pediatrics 110(2 Pt 1):348–353
Gerhardt CA et al (2009) Longitudinal evaluation of a pediatric palliative care educational workshop for oncology fellows. J Palliat Med 12(4):323–328
Roth M et al (2011) Career burnout among pediatric oncologists. Pediatr Blood Cancer 57(7):1168–1173
Guille C et al (2010) Utilization and barriers to mental health services among depressed medical interns: a prospective multisite study. J Grad Med Educ 2(2):210–214
Blanchard P et al (2010) Prevalence and causes of burnout amongst oncology residents: a comprehensive nationwide cross-sectional study. Eur J Cancer 46(15):2708–2715
Shanafelt T, Dyrbye L (2012) Oncologist burnout: causes, consequences, and responses. J Clin Oncol 30(11):1235–1241
Acknowledgements
We would like to thank Dr. Dave Lysecki who contributed significantly to the design of the PC course, the colleagues who helped us with survey design, the colleagues who tutored this course, and the survey participants. We would like to give special recognition to the bereaved parents who shared their time and stories with our fellows.
Funding
Dr. Hasan is funded by the Garron Family Cancer Centre, The Hospital for Sick Children.
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Dr. Hasan conceptualized and designed the project, administered the surveys, extracted and analyzed the data, drafted the initial manuscript, and reviewed and revised the manuscript. Drs. Weingarten and Cada critically reviewed and revised the manuscript for important intellectual content. Dr. Wilejto conceptualized and designed the project, analyzed the data, reviewed, and revised the manuscript.
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Approval for our QI study was granted by our Institutional QI committee. Research Ethics Board (REB) approval was waived based on the nature of this study.
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Consent to participate was implied by the completion of the surveys.
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Hasan, F., Weingarten, K., Cada, M. et al. Palliative Care Training for Pediatric Hematology/Oncology Fellows: a Canadian Perspective. J Canc Educ 38, 167–174 (2023). https://doi.org/10.1007/s13187-021-02094-z
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DOI: https://doi.org/10.1007/s13187-021-02094-z