Are future medical oncologists sufficiently trained to communicate about palliative care? The medical oncology curriculum in Flanders, Belgium.

Background: According to the ‘new international framework’ for palliative care, palliative care should be implemented early in the disease trajectory, preferably starting at the moment of cancer diagnosis. Especially within oncology, effective communication is a prerequisite for qualitative and comprehensive care. This type of communication requires specific communication skills from the oncologist at any stage of the disease continuum (initial diagnosis, relapse, disease progression, discontinuation of active treatments, end-of-life care). Communicating with cancer patients about palliative care is essential. Different types of palliative care (e.g. basic palliative care, specialized palliative care, end-of-life care) should be discussed with cancer patients at different stages of the illness.
In Belgium, medical oncology was officially recognized as a specialty in 2007. The 4 main universities of Flanders (Brussels, Leuven, Antwerp and Ghent) have developed a coordinated educational program for medical oncology inspired by ESMO/ASCO educational recommendations for a medical oncology education program.
Methods: A qualitative research using semi- structured interviews with 9 oncology trainees (cohort 2014-2015) in Flanders. The interviews focused on attitudes and competencies on communication skills to discuss palliative care with patients. Data were transcribed and thematically analyzed to understand the conditions for more adequate communication training specifically for palliative care.
Findings: Trainees receive very little formal training and education in communication tasks, such as giving bad news. Residency and fellowship education is strongly focused on acquiring medical and diagnostic skills at the expense of communication skills. Most fellowship programs do not have a formal curriculum for teaching communication skills.
Discussion: Findings learn that specific attention needs to be paid on the training of (future) oncologists on palliative care in the oncological trajectories of patients. Training should both be part of formal university oncology training programs, especially since care decisions are taken in multidisciplinary teams, and focus on knowledge, attitude and communication competencies with regard to palliative care.