Enhancing Goal-Concordant Care in Oncology: Development and Impact of an Institutional Communication Skills Training Program.

Abstract

As part of the Alliance of Dedicated Cancer Centers' Improving Goal-Concordant Care (IGCC) initiative, we developed and delivered virtual communication skills training (CST) series to improve the quality of serious illness communication and goal-concordant care (GCC) targeting hematologists, medical oncologists, and advanced practice providers (APPs). The CST included two live-virtual workshops: (1) communication frameworks for GCC and difficult conversations and (2) advance care planning (ACP), including documentation and billing. Workshops incorporated didactics, interactive case discussions, role-play exercises, and training in electronic health record documentation and ACP billing. Clinician confidence and feedback were assessed via postworkshop evaluations. Patient-reported experience was assessed using the heard and understood (HAU) scale from Press Ganey surveys. Pre-/post-training changes in top-box HAU scores were analyzed via paired <i>t</i>-tests and mixed-effects modeling. Ninety-three clinicians completed the training evaluation for workshop 1, and 98 completed the evaluation for workshop 2. Over 75% of participants rated content as good or outstanding, with strong gains in self-reported confidence in using ACP tools, Physicians Orders for Life-Sustaining Treatment (POLST) forms, billing codes, and the SPIKES protocol to deliver difficult news. Compared with pretraining scores, physicians demonstrated significant improvement in overall patient-reported HAU scores (79.46 <i>v</i> 83.77, <i>P</i> = .002), particularly for patient perception of being HAU (78.04 <i>v</i> 83.27, <i>P</i> = .012). APPs had higher baseline scores than physicians (90.74 <i>v</i> 78.04, <i>P</i> < .001), with no significant change post-training. Our IGCC CST series improved clinician-reported confidence in applying the learned skills and enhanced patient-reported communication quality among physicians, supporting broader implementation of the training program to strengthen serious illness communication in oncology care.