Discussion
This study demonstrates improvement in specific aspects of patient/family experience for pediatric hematology/oncology providers who chose to undergo RCC skills training. Not only were patients/families more likely to recommend the provider to others after the RCC skills training, but patients/families also specifically reported an improved experience with regard to the information shared about medications, the provider’s concern for patient’s/family’s questions and worries, the provider’s efforts to include the patient/family in decision-making, and the provider’s use of clear language.
This study’s RCC skills course offers an auspicious avenue to fulfill the need for communication training within the field of pediatric hematology/oncology, where providers report they do not feel prepared for difficult conversations.8,17–19 In 2012, only a third of pediatric hematology/oncology fellows in the United States and Canada reported receiving formal communication training in fellowship.18 Similarly, in 2015, only about half of pediatric hematology/oncology fellowship program directors in the United States reported having a formal communication training program.19 Furthermore, the most common methods reported in these surveys were lectures or case scenarios, rather than experiential-based learning methods.
In a 2016, a review by Feraco et al. called for a revitalization of communication skills training in pediatric hematology/oncology. The review specifically advocated for moving beyond role modeling and highlighted workshops’ effective utilization of the experiential learning cycle through a combination of didactic learning, skills practice and reflective feedback.20 Similarly, data within pediatric hematology/oncology and pediatric critical care suggests that workshops are one of the most valuable mechanisms for communication training in difficult conversations.21Although there are barriers to implementing these training strategies, such as time, cost, and lack of faculty expertise in communication skills, even small pediatric hematology/oncology programs (defined as less than 4 fellows per year) have demonstrated the feasibility of such an initiative.19 Current literature suggests specific adjustments, such as the utilization of role play (instead of standardized patients) and investment in home institution faculty development, as ways to pragmatically reduce long term cost for fellowship and faculty programs without significant sacrifices in quality.18,19 Both role play and faculty development were utilized in the current study. Additionally, some pediatric hematology/oncology fellowship programs have recently initiated experiential-based communication skills training with success.18–21 These new training initiatives within pediatric hematology/oncology, along with the current study, strengthen the growing foundation of evidence that communication training that focuses on the patient-provider relationship has the power to change both patient satisfaction and patient outcomes.4,12,22–24
Additionally, although the current study’s intervention was an RCC skills course designed for a multidisciplinary group of pediatric and women’s health providers, the course’s 3 skill sets explicitly address the NCI’s 6 core communication functions in oncology (fostering healing relationships, exchanging information, responding to emotions, managing uncertainty, making decisions, and enabling patient/family self-management ) as well as two novel pediatric functions (providing validation and supporting hope ) described by Sisk et al.14 This course is also congruent with more recent studies focused on the promotion of specific practices to enhance providers’ meaningful connections with patients25 and the transformative potential of RCC for medical education and healthcare in the 21stcentury.26,27
The limitations of the current study include a relatively small sample size (n = 49) and the lack of availability of endpoint data for all providers (n = 15). Although pediatric hematology/oncology fellows have undergone similar communication training at our institution, PGS are not an appropriate outcome to measure the effect on patient experience for fellows, and an expansion of outcome measures is needed to help assess the impact for fellows in the future. Lastly, similar to critique in current literature regarding the impact of communication skills training, this study was not a randomized-controlled trial,28 and a multi-institutional, randomized-controlled study is needed for further validation of the effect on patient/family experience.
In conclusion, we have demonstrated that RCC skills training that focuses on establishing rapport, conveying empathy, eliciting patient/family perspectives, relaying information, and making collaborative decisions with the patient/family is a valuable tool to engender effective communication skills in pediatric hematology/oncology providers to improve patient/family experience. We established our RCC skills training through a collaboration with the ACH and partnered didactics with extensive role-play in a multidisciplinary environment to optimize engagement and experiential learning (Fig. 1). Our experience contributes to increasing evidence that there are a variety of resources and learning environments from which institutions can choose to build a successful program.