3C-1: Role plays: how to build a useful tool to teach students communication with cancer patients

Jean-Francois Heron, Sabine Noal, Pierre-Emmanuel Brachet, Paul Lesueur, Lucile Debonnaire
Centre Francois Baclesse, Caen, France

Abstract: Background: Every GP has to dialog with cancer patients: either during diagnosis, treatment, follow-up or palliative care. Thus, communication skill is most important and should be trained during medical studies. In our Country, however, most often, students learn through companionship with physicians and specific systematic training is rarely organized. Methods: Since 2008, in our Cancer Centre, we organize every two weeks role plays for 4th to 6th year medical students. During all these years, our methods have improved, allowing safe and fruitful plays as well as animated discussions between acting and observing students. We will present an evaluation of the role plays by the students. Furthermore, since the main animator is going to retire, we are now in the process of transmitting his acquired competence to younger motivated teachers. We organize specific training sessions to teach the methodology and the know-how, concentrating on skill communications, patient’s defense mechanisms, and physician’s defense mechanisms. Analysis of the dialogs between doctors and sham patients will be the main subject of these sessions. To analyze nonverbal communication, we benefit from the help of a theater director. Results – Discussion: Almost every student positively evaluated this communication training. Know-how transmission necessitates a personal questioning about previous experience in order to adapt one’s companionship to the needs of younger generation. Relation to Theme: There are great diversity among patients and physicians in their way to announce bad news. Communication skill is necessary to establish a good contact with the patient, in order to let him be a real partner for his (her) care. Learning Objectives: The participants should be able to understand the benefits to propose role plays to students and the main process to build such a teaching method. He(she) should be aware of the difficulties and limits of the method. References: 1. The effect of using standardized patients or peer role play on ratings of undergraduate communication training: A randomized controlled trial. 2. Hans Martin Bosse, Jobst-Hendrik Schultz, Martin Nickel, et al. 3. Patient Education and Counseling 87 (2012) 300–306. 4. Comparing three experiential learning methods and their effect on medical students’ attitudes to learning communication skills. 5. Jonna KOPONEN,, Eeva PYORALA, Pekka ISOTALUS Medical Teacher 2012 e198–e207.

3C-2: Making Nurses Competent: Using Simulation Learning to Educate About Safe Handling of Hazardous Drugs and Body Fluids

Leah Scaramuzzo
Billings Clinic, Billings, MT, USA

Abstract: Background/Purpose: Studies demonstrate that healthcare workers exposed to hazardous drugs (HDs) are at risk for acute and significant long-term adverse health effects. The use of personal protective equipment (PPE) has been found to reduce the risk of developing health problems. Therefore national organizations have published guidelines and recommendations for healthcare workers handing HDs and body fluids. On an inpatient oncology unit, it was identified that nursing practice in the care of patients receiving HDs was inconsistent with these guidelines related to lack of knowledge and access to PPE. Description: After meeting with key stakeholders, proper PPE was ordered for the unit. An alert was built in the electronic medical notifying staff of HD precaution patients. Educational curriculum was developed incorporating didactic and hands-on competency evaluation. Objectives included identifying the potential adverse effects of handling HDs and demonstrating use of recommended PPE. Using a train-the trainer approach, skills stations were created and held in the hospital’s simulation laboratory. Staff were presented with case scenarios: HD precaution preparation of patient room, disposal of body waste from urinal, clean-up of accidental spill of body waste, management of drug spill, removal/disposal of PPE, and education of patient/family regarding precautions. Staff rotated through each skill station demonstrating management of each situation. Evaluation: Training evaluations included comments that learning the risks of exposure to HDs assisted in understanding the importance of using PPE. Staff also noted that real-life patient scenarios better prepared them for patient care. Rounding audits demonstrated 100% compliance with the guidelines. Usefulness: As more hazardous drugs are administered in the inpatient setting, including oral oncolytics, healthcare workers are at increased risk for exposure to HDs. This education model can easily be adapted to educate staff and confirm competency in safe handling of HDs and body fluids. Relation to Theme: This project is innovative in that it used an education modality of simulation experiential learning in addition to didactic education. This enabled learners to use a hands-on approach to learning while validating learning outcomes. Learning Objectives: The participant shall be able to identify two strategies to assist in compliance with using personal protective equipment when caring for patients receiving hazardous drugs. References: 1. Polovich, M., Olsen, M., & LeFebvre, K.B. (Eds.). (2014). Chemotherapy and biotherapy guidelines and recommendations for practice (4th ed.). Pittsburgh, PA: Oncology Nursing Society. 2. Polovich, M. (2011). Safe handling of hazardous drugs (2nd ed.) Pittsburgh, PA: Oncology Nursing Society.

3C-3: A Multidisciplinary Curriculum at the Interface of Diet, Obesity and Cancer

Xavier Pi Sunyer, Susan Ettinger
New York Obesity Research Center, New York, NY, USA

Abstract: Background: Cancer and obesity are increasing worldwide. Obesity is associated with increased death rates not only for cancers at specific sites, but for all cancers combined. Molecular mechanisms for this relationship remain unclear, however obesity-associated metabolic dysregulation and chronic inflammation have been implicated. Diet plays a pivotal role in the pathogenesis of both obesity and cancer. The diverse chemical components contained in the diet modify the microbiota, thus directly or indirectly regulating signaling pathways, gene expression, and immune responsiveness. Despite its great potential as a cost-effective adjuvant strategy to prevent primary cancers, minimize stem cell driven metastases and inhibit impending recurrence, and to synergistically improve treatment efficacy, targeted diet modification is seldom utilized at its full potential by health professionals. Description: We were funded by NIH to develop an innovative curriculum integrating research on the role of diet components in pathways leading to obesity and its comorbidities, including cancer. We constructed case modules with extensive resource sections that reviewed relevant mechanistic evidence around the actions of dietary components on disease pathways and on published evidence suggesting that targeted diet modification can be effective in preventing comorbid conditions and/or slowing disease progression. Evaluation: Qualitative evaluation of the curriculum by postdoctoral fellows, physicians and health science students revealed that the material was well accepted and can be utilized at multiple levels across health care spectrum. We are presently formatting this curriculum as a text for training health science students. Usefulness: We believe that this curricular model will stimulate research into the utility of targeted diet modification in the prevention of obesity and cancer and as a cost-effective adjuvant to medical therapy in minimizing obesity comorbidities and cancer metastases and recurrence. Relation to Theme: We expect that this curriculum will stimulate research and provide support for policy initiatives aimed at reducing obesity comorbidities including cancer. The targeted use of diet in cancer prevention and control can reduce costs and address social and cultural cancer disparities prevalent in the US and globally. Learning Objectives: Objectives: The participants will be able to recognize a specific cancer that is strongly linked to diet and obesity. The participants will be able to identify mechanisms through which diet and/or obesity predispose to cancer risk. The participants will be able to pinpoint actions of a diet component that reduce risk for both obesity and cancer. References: 1. Mariotto A. et al. 2011. Projections of the Cost of Cancer Care in the United States: 2010–2020 JNCI J Natl Cancer Inst 103 (2): 117-128 doi:10.1093/jnci/djq495 Li Y. et al. 2011. Implications of cancer stem cell theory for cancer chemoprevention by natural dietary compounds. Journal of Nutritional Biochemistry , Volume 22 , Issue 9 , 799 – 806 doi: http://dx.doi.org/10.1016/j.jnutbio.2010.11.001 Lee CS. et al. 2015. Visceral Adiposity is a Risk Factor for Poor Prognosis in colorectal Cancer Patients Receiving Adjuvant Chemotherapy. Journal of Gastrointestinal Cancer . Published on-line April, 2015. Doi: 10.1007/s12029-015-9709-0.

3C-4: Outcome Assessment of Interprofessional Communication Training for Hospital-Based Teams

Elaine Wittenberg¹, Joy Goldsmith², Betty, Ferrell¹, Sandra Ragan³, Jo Hanson^1
1City of Hope Comprehensive Cancer Center, Duarte, CA, USA, ²University of Memphis, Memphis, TN, USA, ³University of Oklahoma, Norman, OK, USA

Abstract: Background/Purpose: Communication training for healthcare providers has traditionally focused on single disciplines. Yet, oncology care is increasingly delivered by interprofessional teams of healthcare professionals. The purpose of this presentation is to describe a statewide effort to improve team-based communication provided by interprofessional healthcare teams in hospital settings. Methods: The project was based on the COMFORT Communication Curriculum, a national palliative care communication training curriculum based on communication theory and research in palliative care. With funding from the Archstone Foundation in California, the curriculum was created for a two-day training course for implementing evidence-based communication skills into practice. Using the National Consensus Project’s Clinical Practice Guidelines for Palliative Care and the Core Competencies for Interprofessional Practice sponsored by the American Association of Colleges of Nursing and the Association of American Colleges of Medicine, the curriculum was built by a team of interprofessional faculty. Results/Findings: The COMFORT Curriculum for Palliative Care Teams includes teaching materials, training videos, and supplemental resources to integrate communication skills building into existing clinical settings. Statewide interprofessional communication training took place in January, 2015 with 30 palliative care teams (2 providers per team). Physicians, nurses, social workers, and chaplains rated the course as excellent with a mean score of 4.81 (on a scale of 1=poor to 5=excellent), found the course stimulating (4.91), and met expectations (4.76). Discussion: This presentation will focus on the 6 and 9 month post course goal evaluations with emphasis on models of excellence and barriers cited. This statewide training (www.pccinstitute.com) provides healthcare professionals with education on team-based care and communication, developing the skills needed to integrate palliative care into hospital systems and improve access and services to patients and families. Relation to Theme: This abstract summarizes outcomes of an innovative, team-based communication training program for hospital-based team members representing medicine, nursing, social work, chaplains, and psychology. Learning Objectives: At the completion of this session, the participants will be able to: 1. Identify a statewide project to coordinate interprofessional communication training to improve inpatient care. 2. Describe at least two models of excellence and barriers to team-based care in the hospital setting. 3. Describe at least two teaching resources to enhance team communication competence in the hospital setting. References: 1. Bilodeau K, Dubois S, Pepin J. Interprofessional patient-centred practice in oncology teams: utopia or reality? J Interprof Care 2015;29:106-12. 2. Klarare A, Hagelin CL, Fürst CJ, Fossum B. Team Interactions in Specialized Palliative Care Teams: A Qualitative Study. Journal of Palliative Medicine 2013;16:1062-9.

3C-5: Trends in Federally Funded Cancer Training Awards: Where do we go from here?

Jennifer Davis, Emilyn Banfield, Shine Chang
University of Texas MD Anderson Cancer Center, Houston, TX, USA

Abstract: Background: By 2020, increasing cancer incidence and advances in survivorship mean that demand for oncologists in the US will exceed projected supply (1). As much cancer is preventable, improving cancer prevention, early detection, and our fundamental understanding of carcinogenesis are necessary to alleviate the burden on oncologists and the public health. Given projected shortages in the health care workforce, we evaluated the state of NCI funding for cancer training and education. Methods: Information on fellowship and career awards, institutional training awards, and location of cancer centers from FY2000-2012 and FY2007-2012 was gathered from the National Institutes of Health RePORT website. Institutional training program data were analyzed by program type and individual award mechanisms were categorized as F- or K-series awards and based on career stage. Findings: Contributing the third largest dollar amount spent on training (approximately 8% of all NIH training funds), the National Cancer Institute (NCI) has seen growth in training funds since 1999. However, analysis by mechanism revealed variations in funding. For example, the number of institutional training program awards (T32) declined, with numbers of new awards decreasing dramatically. This has consequences for building the cancer workforce across the country. Specifically, of the 29 states without NCI T32 programs (n=163), 14 have no NCI cancer centers to help sponsor such applications. Also, shifts in emphasis in the NCI Cancer Training Branch are being passively enacted by the non-renewal of award mechanisms as they expire, including those targeting cancer prevention and control, raising concern. Discussion: Despite progress, cancer health disparities persist in care, geography, income, education, race/ethnicity, and even gender. Further, maximal uptake of effective cancer screening methods by those recommended for them remains elusive (2). This suggests that we should reconsider dedication of funds for training more people to quicken the pace and reduce the burden of cancer through prevention.Relation to Theme: Without sufficient support to recruit and train professionals to advance cancer prevention and reduce health disparities, we cannot hope to reduce significantly the projected impact of cancer on the future cancer workforce dedicated to health care. Learning Objectives: The participant shall be able to describe at least two reasons why greater emphasis on training professionals in cancer prevention and control can help reduce the cancer burden on public health. References: 1. Erikson, C., et al., Future supply and demand for oncologists: challenges to assuring access to oncology services. J Oncol Pract, 2007. 3(2): p. 79-86. 2. James AS, Gehlert S, Bowen DJ, Colditz GA. A framework for training transdisciplinary scholars in cancer prevention and control. J Ca Educ, 2015 (in press).