Similarly, AYA patients may existentially mature faster than anticipated or reveal a premature wisdom from posttraumatic growth.39 Insight into behavior such as nonadherence to medication, risk-taking, or questioning of authority within the context of AYA identity can help in trainee interactions with AYAs.40

Younger AYAs often have a sense of immortality, which is sometimes reflected in their inconsistent treatment compliance.41 Younger AYAs may also engage in risky activities during treatment (eg, consumption of alcohol), often in an attempt to fit in with peers and counter feelings of rejection.42

Table 1 provides a developmentally informed perspective on supporting QOL at EOL with informed consideration of AYA developmental needs. As AYAs with cancer brave developmental transitions, so their clinicians should brave growing in knowledge of palliative care to transition toward earlier integration that is developmentally appropriate.


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(To view a larger version of Table 1, click here.)

TRAINING INTERVENTIONS: INSTRUCTIONAL STRATEGIES

Essential components of AYA palliative care education include longitudinal access, reflection, mentorship, and purposeful teaching strategies.

Longitudinal exposure enables trainees to follow a patient with a sense of personal responsibility, witness changing psychosocial dynamics, and engage in committed partnership.43

Personal reflection and team debriefings assure acquisition of professional assiduousness and emotional coping.44 Mentors who adopt “teachable moments” at the bedside enable trainees to witness skills and shared vulnerabilities in a real environment.45,46

Deliberate provision of written goals and real-time guides for palliative care trainees could legitimize topics as valid educational points.

Teaching palliative domains requires variability within programs. For example, knowledge areas such as opioid conversion may be taught in calculation tutorials, whereas attitudinal areas such as truth-telling require theoretical teaching with mentored clinical exposure.47,48

In the setting of minimal protected curricular time and a shortage of palliative care providers, intentional exposure to diverse teaching modalities equips instructors with practical teaching tools and enables learners with an accessible knowledge base (Table 2).

The reality of palliative care as a young and an understaffed field has led to the prioritization of educating trainees as palliative care champions to share their knowledge in local settings.

(To view a larger version of Table 2, click here.)