Establishing and maintaining a therapeutic alliance with an AYA requires attentiveness to the content and quality of communication, an approach most effectively realized through in-person training.
A survey of clerkship directors revealed that lectures and small-group discussions were the most common palliative training modalities.49
However, residents and directors of pediatric residency programs have reported palliative care learning was best accomplished at the bedside (close to an actual encounter) and during rounds as experiential learning opportunities.45
Structured home visits and hospice rotations within palliative care curricula would enhance personal and professional trainee development.50
Didactic and day-to-day training opportunities
Medical students receiving formal didactic and day-to-day EOL training report being more comfortable with palliative care and have an improved knowledge base with measurably increased competence in delivering palliative care.51,52
Posttest assessments reveal that even short-duration interventions, such as a 2-week palliative care rotation for residents, lead to knowledge improvement.53
An ongoing question is whether empathy is innate and the role communication skills have in improving empathic care. In a randomized controlled trial (RCT), residents’ communication skills and responses to patients’ emotions improved significantly after a 1-day EOL communication skills retreat.54
In an RCT, testing whether an empathy protocol could improve physician empathy, residents receiving the training modules were rated as more understanding, compassionate, and caring by patient reviewers than those not receiving the empathy modules.55
Inexpensive discussion-based seminar series can successfully provide pediatric residents with foundational information on EOL care and considerably increase their confidence when caring for seriously ill or dying patients.56
Peer-training formats recognize students share “cognitive and social congruence”, which may bridge generational gaps.57
Shared learning opportunities
To build a truly collaborative relationship, it is important for AYA care clinicians to engage with the palliative care team through a joint consultation with a member of the palliative care team or through periodic joint patient visits.58
These joint sessions model for trainees a practical way to ensure AYAs and families receive a strong message that the primary oncologist is not abandoning them, but rather that they are participating in providing comprehensive support within an interdisciplinary format.
Bereaved family members as educators
Bereaved parents have been utilized in educating health-care professionals in several settings, including being a part of a parent panel at conferences, or participating in facilitated, small-group discussions with staff.56,59–62
While most family members have been parents who have experienced the death of a child, grandparents and siblings have also participated. A study examining a program that utilized bereaved parents in an 8-week luncheon training series for health-care providers was evaluated to study motivations, expectations, challenges, benefits, and meaning-making.62
During the sessions, parents took an active role in the facilitated discussions surrounding topics relating to communication, family support, EOL support and care, and death. While the study sample was limited to one site, health-care professionals identified more benefits than burdens from bereaved parents’ participation in the care trainings.
Strategies for palliative care teaching have included web-based learning modules.63 Since everyone cannot attend annual conferences, online immersive learning is an increasingly feasible option for expanding access through flexible teaching formats.
Distance learning protects participants’ resources and allows them to receive training at their own pace and location. Online teaching formats recognize the technological strengths of this “social media” generation of learners by partnering self-paced learning with collaborative conversations on live web platforms.
Ideally, providers should be able to combine live training interactions with distance-learning modules to translate knowledge obtained via technology into real-time patient care.