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Background Burnout is a critical factor that can influence the quality of care that doctors provide to their patients. Previous research suggests a link between inadequate communication skills training and burnout, and various approaches to enhance communication skills have been explored as a means to address this issue. However, evidence of the effect of these approaches is lacking. The aim of this study is to assess the effect of the novel On-site Supportive Communication Training (On-site SCT) in enhancing communication skills among oncologists and thereby addressing burnout. Methods This randomized, controlled, multicenter study was conducted across three oncological departments in Denmark. Doctors were eligible if they worked in the outpatient clinic at least four days per month and provided informed consent. Doctors in the intervention group underwent a two-hour introduction followed by three full days of On-site SCT facilitated by in-house psychologists, while those in the control group continued standard practices. Pre- and post-intervention assessments on burnout (Copenhagen Burnout Inventory) were conducted, as were assessments of related constructs (job satisfaction and communication self-efficacy). Differences in pre- and post- assessments were analyzed using a paired t-test. Feasibility was assessed descriptively by comparing intervention days with planned schedule, and doctors’ satisfaction with the intervention was assessed systematically by questionnaire. Results Of 101 screened doctors, 89 (88%) consented and were randomized. 65% were female, and the mean age was 46 (range 27 to 75). Due to nine exclusions, data from 39 doctors in the intervention group and 41 doctors in the control group were available for analysis. At baseline, doctors exhibited lower levels of burnout than reported in international literature. No statistically significant improvements in burnout ( p  > 0.05) were demonstrated post-intervention. Despite non-significant changes, the doctors reported an improvement in communication self-efficacy. The program showed high feasibility and received positive feedback from participating doctors. Conclusions Our findings caution against assuming a causal relationship between short-term interventions and a complex phenomenon like burnout. On-site SCT demonstrated high feasibility, participation rate and acceptance. This underscores its potential value in clinical settings. Consequently, On-site SCT will be implemented at the Department of Oncology, Vejle University Hospital, to facilitate further refinement based on ongoing feedback and to explore long-term outcomes. Trial registration December 2022– The Region of Southern Denmark (22/57137). April 2023– ClinicalTrials.gov (NCT05842083). April 2023– The Research Ethics Committee at the University of Southern Denmark (23/19397).

Background LGBT patients may have unique psychosocial cancer care needs, and healthcare providers should have knowledge and understanding of these unique needs to effectively address disparities through the delivery of personalized healthcare. As such, our group developed and piloted a web-based LGBT cultural competency training designed specifically for oncologists called the Curriculum for Oncologists on LGBT populations to Optimize Relevance and Skills (COLORS). We designed a randomized pragmatic trial for oncologists to compare the effectiveness of the COLORS training versus a general online LGBT cultural competency training in improving LGBT-related knowledge, attitudes, and clinical practices. Methods/design Study procedures include an 8-step approach for recruitment, randomization, retention, and completion of the interventions. Oncologists of any subspecialty who are currently practicing physicians will be identified from the American Medical Association Masterfile. Approximately 5000 oncologists will be sent a FedEx envelope with an invitation letter and study timeline. Electronic consent is obtained using a secure REDCap (Research Electronic Data Capture) portal hosted at the Moffitt Cancer Center (Tampa, FL) where the oncologists will complete the eligibility questionnaire, pre-training assessments, and then will be randomized to complete the COLORS training or an online general healthcare training offered by the National LGBT Health Education Center. Effectiveness of both trainings will be assessed utilizing self-reported measures of LGBT-related knowledge, attitudes, and affirming clinical practices. The measures will be collected before and directly after training completion, as well as 3-month post-training completion. The primary outcomes are changes in knowledge, attitudes, and practice behaviors regarding LGBT cancer patients from pre-test to post-test training in the COLORS training vs. the comparison training. Discussion The overarching premise of this trial is to assess the effectiveness of the COLORS cultural competency training program. If successful, among oncologists who completed the COLORS training should yield statistically significantly improvements in knowledge, attitudes, and affirming practice.

Purpose Many cancer patients wish for complementary and integrative medicine (CIM) consultations led by their oncology physician. Within the KOKON‐KTO study, oncology physicians in the intervention group were trained in a blended learning to provide CIM consultations to their cancer patients in addition to distributing a leaflet about CIM websites. Control oncology physicians only distributed the leaflet. The training showed positive effects on the patient‐level. As of now, no consistent evidence exists on the long‐term effects of such one‐time‐only CIM consultation during cancer treatment. Methods In the KOKON‐KTO follow‐up study, cancer patients previously participating in the KOKON‐KTO study (intervention group:IG and control group: CG) received, at least 24 months later, a follow‐up questionnaire by post, evaluating long‐term effects of the KOKON‐KTO consultation using the measures provided in the original study (patient‐physician communication (EORTC‐QLQ‐COMU2), satisfaction with cancer treatment (PS‐CaTE), CIM disclosure with healthcare provider (HCP), and need for CIM consultation during cancer therapy). Results In total, 102 cancer patients participated in the follow‐up study (IG n = 62; CG n = 40). The overall reponse rate was around 36% (IG: 48.4%; CG: 23.7%). In the follow‐up study, differences between groups had increased and were still shown (EORTC‐QLQ‐COMU26, 0–100 point scale, ≥10‐point‐group difference) in some subscales: patient's active behavior (in means; IG:73.6 (95% CI, 63.8–83.5); CG:61.1 (95% CI, 52.4–69.8)); clinician‐patient relationship (IG:80.9 (95% CI, 71.8–90.0); CG:68.7 (95% CI, 59.3–78.0)). For some outcomes, differences decreased over time (e.g., EORTC‐QLQ‐COMU26 subscales “takes into account patient's preference” and “corrects misunderstandings”). More patients in the CG used CIM without oncology physicians' knowledge (IG: 13.7%, CG: 24.0%). Conclusion This study presents first findings that one‐time‐only CIM consultations may enhance patient‐physican relationship and CIM disclosure long‐term. To further support cancer patients' in their wish for CIM consultations, training programs should provide oncology physicians with CIM competencies for different cancer stages including cancer survivors.

Background Oncological patients often feel left out of important treatment decisions. However, when physicians engage them in shared decision-making (SDM), patients benefit in many ways and the situation is improved. SDM can effectively be taught to physicians, but participation barriers for SDM physician group trainings are high, making it hard to convince physicians to participate. With this in mind, we aim to develop and evaluate two new dissemination strategies for a brief, SDM training program based upon a proven SDM group-training concept: an individualized context-based SDM face-to-face training (IG I) and a web-based interactive SDM online training (IG II). We aim to analyze which improvements can be achieved by IG I and II compared to a control group (CG) in physician SDM competence and performance as well as the impact on the physician-patient relationship. Furthermore, we analyze differences in satisfaction concerning the two dissemination strategies by means of a training evaluation. Methods/design We examine – based on a three-armed randomized controlled trial (IG I, IG II, CG) – the effectiveness of two new dissemination strategies for a SDM training program compared to a CG receiving no SDM training (voluntary access to SDM training as an incentive for participation after completion of the study). We aim to include 162 physicians randomized to one of the three arms. There will be two assessment points in time (before intervention: T 0 and post-training: T 1 ). The main outcome is the SDM competence of physicians as measured by an established observational assessment rating system (OPTION-12) by means of consultations with Standardized Patients. Standardized Patients are individuals trained to act as “real” patients. Secondary outcome measures are the SDM performance (SDM-Q-9) and the Questionnaire on the Quality of Physician-Patient-Interaction (QQPPI) both rated by Standardized Patients as well as the physicians’ training evaluation. Discussion This trial will assess the effectiveness and acceptability of two new dissemination strategies for a brief, SDM training program for physicians. Opportunities and challenges regarding implementation in daily routines will be discussed. Trial registration ClinicalTrials.gov, Identifier: NCT02674360 . Prospectively registered on 4 February 2016.

Purpose To improve shared decision making (SDM) with advanced cancer patients, communication skills training for oncologists is needed. The purpose was to examine the effects of a blended online learning (i.e. e-learning and online training session) for oncologists about SDM in palliative oncological care and to compare this blended format with a more extensive, fully in-person face-to-face training format. Methods A one-group pre-posttest design was adopted. Before (T0) and after (T2) training, participants conducted simulated consultations (SPAs) and surveys; after the e-learning (T1), an additional survey was filled out. The primary outcome was observed SDM (OPTION12 and 4SDM). Secondary outcomes included observed SDM per stage, SPA duration and decision made as well as oncologists’ self-reported knowledge, clinical behavioural intentions, satisfaction with the communication and evaluation of the training. Additionally, outcomes of the blended learning were compared with those of the face-to-face training cohort. Analyses were conducted in SPSS by linear mixed models. Results Oncologists ( n  = 17) showed significantly higher SDM scores after the blended online learning. The individual stages of SDM and the number of times the decision was postponed as well as oncologists’ beliefs about capabilities, knowledge and satisfaction increased after the blended learning. Consultation duration was unchanged. The training was evaluated as satisfactory. When compared with the face-to-face training, the blended learning effects were smaller. Conclusion Blended online SDM training for oncologists was effective. However, the effects were smaller compared to face-to-face training. The availability of different training formats provides opportunities for tailoring training to the wishes and needs of learners.

Background Excessive opioid prescribing is common in surgical oncology, with 72% of prescribed opioids going unused after curative-intent surgery. In this study, we sought to reduce opioid prescribing after breast and melanoma procedures by designing and implementing an intervention focused on education and prescribing guidelines, and then evaluating the impact of this intervention. Methods In this single-institution study, we designed and implemented an intervention targeting key factors identified in qualitative interviews. This included mandatory education for prescribers, evidence-based prescribing guidelines, and standardized patient instructions. After the intervention, interrupted time-series analysis was used to compare the mean quantity of opioid prescribed before and after the intervention (July 2016–September 2017). We also evaluated the frequency of opioid prescription refills. Results During the study, 847 patients underwent breast or melanoma procedures and received an opioid prescription. For mastectomy or wide local excision for melanoma, the mean quantity of opioid prescribed immediately decreased by 37% after the intervention ( p  = 0.03), equivalent to 13 tablets of oxycodone 5 mg. For lumpectomy or breast biopsy, the mean quantity of opioid prescribed decreased by 42%, or 12 tablets of oxycodone 5 mg ( p  = 0.07). Furthermore, opioid prescription refills did not significantly change for mastectomy/wide local excision (13% vs. 14%, p  = 0.8), or lumpectomy/breast biopsy (4% vs. 5%, p  = 0.7). Conclusion Education and prescribing guidelines reduced opioid prescribing for breast and melanoma procedures without increasing the need for refills. This suggests further reductions in opioid prescribing may be possible, and provides rationale for implementing similar interventions for other procedures and practice settings.

Background Systemic treatment for advanced cancer offers uncertain and sometimes little benefit while the burden can be high. Hence, treatment decisions require Shared Decision Making (SDM). The CHOICE trial examines the separate and combined effect of oncologist training and a patient communication aid on SDM in consultations about palliative systemic treatment. Methods A RCT design with four parallel arms will be adopted. Patients with metastatic or irresectable cancer with a median life expectancy <12 months who meet with a medical oncologist to discuss the start or continuation of palliative systemic treatment are eligible. A total of 24 oncologists (in training) and 192 patients will be recruited. The oncologist training consists of a reader, two group sessions (3.5 h; including modelling videos and role play), a booster feedback session (1 h) and a consultation room tool. The patient communication aid consists of a home-sent question prompt list and a value clarification exercise to prepare patients for SDM in the consultation. The control condition consists of care as usual. The primary outcome is observed SDM in audio-recorded consultations. Secondary outcomes include patient and oncologist evaluation of communication and decision-making, the decision made, quality of life, potential adverse outcomes such as anxiety and hopelessness, and consultation duration. Patients fill out questionnaires at baseline (T0), before (T1) and after the consultation (T2) and at 3 and 6 months (T3 and T4). All oncologists participate in two standardized patient assessments (before-after training) prior to the start of patient inclusion. They will fill out a questionnaire before and after these assessments, as well as after each of the recorded consultations in clinical practice. Discussion The CHOICE trial will enable evidence-based choices regarding the investment in SDM interventions targeting either oncologists, patients or both in the advanced cancer setting. The trial takes into account the immediate effect of the interventions on observed communication, but also on more distal and potential adverse patient outcomes. Also, the trial provides evidence regarding the assumption that SDM about palliative cancer treatment results in less aggressive treatment and more quality of life in the final period of life. Trial registration Netherlands Trial Registry number NTR5489 (prospective; 15 Sep 2015).

BackgroundMRI-US fusion prostate biopsies are becoming a common procedure to diagnose prostate cancer. There is a paucity of information regarding the learning curve for fusion biopsies. We aim to study the amount of experience needed to be both accurate and time-efficient in this procedure.MethodsWe prospectively collected data on all MRI-US fusion biopsies performed from April 2014 to August 2017. We used two parameters to define the learning curve. Process Measurement (efficiency) was measured by time from the beginning of anesthesia to end of procedure. Outcome Measurement (accuracy) was measured by cancer detection rate for PI-RAD 3 lesions. The end of the learning curve was defined graphically and mathematically. We performed a separate analysis for transrectal and transperineal biopsies.ResultsWe completed 779 fusion biopsies (523 transrectal, 256 transperineal). Patients median age was 66 years (IQR 61–70) and median PSA 6.95 ng/ml (IQR 4.2–10.6). Prostate cancer was diagnosed in 385 (49%). Process Measurement—Procedure time decreased from 45 min in the first transrectal fusion biopsy to 15 min after 109 biopsies and remained stable (p < 0.0001). Time decreased from 55 min in the first transperineal biopsy to 18 min after 124 biopsies (p < 0.0001). Outcome Measurement—In transrectal fusion-biopsies detection rate for PI-RADS 3 lesions increased from 35 to 50% after 104 biopsies. In transperineal fusion-biopsies, detection rate increased from 40 to 55% after 119 cases for PI-RADS 3 lesions.ConclusionsWe measured the learning curve of fusion biopsies graphically and mathematically. We demonstrated that proficiency occurs after 110 transrectal and 125 transperineal fusion-biopsies.

Providers oftentimes need to have difficult conversations with patients facing a poor prognosis. Research indicates that providers generally feel ill prepared for these conversations and that bad conversations may lead to more anxiety for patients. Communication skills development training programs have shown improvement in providers’ skills. Our cancer center embarked on skills development training to help providers improve their skills and comfort in having serious illness conversations. During our phased approach, about 500 physicians and advanced practice providers in the Division of Oncology were trained for over a year. Their level of comfort with serious illness conversations was measured before and after the training by using both quantitative and qualitative methods. We found that mean and median comfort scores increased from pre-training to post-training. The findings suggest that the improved comfort and confidence observed among providers who undergo communications skills training can lead to better provider-patient communication, more patient-centered care, and improved patient satisfaction.

Several recent advances in gynecologic cancer care have improved patient outcomes. These include national screening and vaccination programs for cervical cancer as well as neoadjuvant chemotherapy for ovarian cancer. Conversely, these advances have cumulatively reduced surgical opportunities for training creating a need to supplement existing training strategies with evidence-based adjuncts. Technologies such as virtual reality and augmented reality, if properly evaluated and validated, have transformative potential to support training. Given the changing landscape of surgical training in gynecologic oncology, we were keen to summarize the evidence underpinning current training in gynecologic oncology. In this review, we undertook a literature search of Medline, Google, Google Scholar, Embase and Scopus to gather evidence on the current state of training in gynecologic oncology and to highlight existing evidence on the best methods to teach surgical skills. Drawing from the experiences of other surgical specialties we examined the use of training adjuncts such as cadaveric dissection, animation and 3D models as well as simulation training in surgical skills acquisition. Specifically, we looked at the use of training adjuncts in gynecologic oncology training as well as the evidence behind simulation training modalities such as low fidelity box trainers, virtual and augmented reality simulation in laparoscopic training. Finally, we provided context by looking at how training curriculums varied internationally. Whereas some evidence to the reliability and validity of simulation training exists in other surgical specialties, our literature review did not find such evidence in gynecologic oncology. It is important that well conducted trials are used to ascertain the utility of simulation training modalities before integrating them into training curricula.