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.