Communication Training in Pediatric Hematology/Oncology: A Canadian National Needs Assessment

Background. Communication skills are crucial in Pediatric Hematology/Oncology (PHO) due to clinical complexity and the need to balance child and parent interactions. Communication skills of Canadian PHO trainees are evaluated by nationally standardized Entrustable Professional Activities (EPAs) in a competency by design framework. While PHO communication training in the United States is limited (File et al. 2014), there is no published data for Canadian training programs.

Objectives. 1) To characterize communication training in Canadian PHO programs. 2) To explore the perspectives of PHO trainees and Program Directors (PDs) on communication training.

Methods. We conducted a mixed methods national needs assessment per Kern’s Model of Curriculum Development, using an explanatory sequential design. Eligible participants were Canadian PHO PDs and current trainees, excluding subspecialty fellows (e.g. bone marrow transplant). An electronic survey, optimized with statistician input, cognitive interviewing, and pilot testing, was distributed via RedCap. Data were analyzed with descriptive statistics. Respondents were invited to a focus group (trainees) or one-on-one interview (PDs), with interview guides informed by survey results. De-identified transcripts were coded using NVivo by 2 authors (KM, MT) with a deductive approach, and analyzed with reflexive thematic analysis. Participants received gift certificates. This project was designed as part of the ASH Medical Educators Institute and funded by the Alberta Children's Hospital Foundation and Department of Pediatrics Innovation Award.

Results. Survey was completed by 7 PDs and 12 trainees, representing 9/10 Canadian PHO programs. Most participants (84%) identified as female.

Zero to 10 hours/year of communication training was reported including workshops (8/9 programs), didactic lectures (6/9), simulation (3/9), and other methods, mostly delivered by PHO and palliative care physicians.

Attitudes were assessed with a 5-point Likert scale from “strongly disagree” to “strongly agree.” Participants felt dedicated communication training is required (17/19 agreed, 2 neutral). PDs were more likely than trainees to report direct observation (86% vs 58%) and adequate evaluation (71% vs 42%) of trainee communication skills. Trainees preferred active teaching methods (simulation, peer/faculty feedback, and workshops) whereas PDs favoured passive methods (peer/faculty feedback, observing faculty, and observing peers). Trainees (58%) and PDs (86%) showed interest in simulation if available.

Comfort with 15 communication scenarios (e.g. “disclosing an oncology diagnosis”) was assessed on a 5-point Likert scale from “very uncomfortable” to “very comfortable.” Trainees were least comfortable discussing autopsy requests (11/12 neutral or worse), survival data comparisons (9/12 neutral or worse), and clinical trial enrolment (7/12 neutral or worse). PDs were statistically more comfortable with 8/15 scenarios (p<0.05), with only sexual health and gender identity scored below neutral by any PD.

Preliminary qualitative thematic analysis revealed 4 main themes: desire for PHO-specific communication training; barriers to curriculum development (e.g. budget and time constraints); need to improve communication evaluation; and need for collaboration between programs.

Conclusion. There is a need for improved communication training in Canadian PHO programs. Participants desired increased training (passive modalities preferred by PDs and active ones favored by trainees), improved evaluation, and better inter-program collaboration. These findings will guide the development of a pilot PHO communication curriculum.