Oral Presentation Clinical Oncology Society of Australia Annual Scientific Meeting 2022

Improving capacity for equitable end-of-life communication for adolescents and young adults with cancer: what training do health-professionals need to facilitate best-practice? (#25)

Ursula M Sansom-Daly 1 2 3 , Lori Wiener 4 , Abby Rosenberg 5 6 7 , Meaghann Weaver 8 , Hanneke Poort 9 , Anne-Sophie Darlington 10 , Fiona Schulte 11 12 , Anthony Herbert 13 14 , Louise Sue 15 , Antoinette Anazodo 2 3 , Susan Trethewie 16 , Ruwanthie Amanda Fernando 17 , Richard J Cohn 1 2 , Toni Lindsay 18 , Leigh Donovan 19 , Jennifer Mack 20 , Holly E Evans 1 2 21 , Maria Cable 22 , Afaf Girgis 23 , Claire E Wakefield 1 2
  1. Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia
  2. School of Clinical Medicine, UNSW Medicine and Health, UNSW Sydney, Kensington, NSW, Australia
  3. Sydney Youth Cancer Service, Prince of Wales/Sydney Children's Hospitals, Randwick, NSW, Australia
  4. Psychosocial Support and Research Program, Paediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
  5. Palliative Care and Resilience Research, Seattle Children's Research Institute, Seattle, Washington, USA
  6. Adolescent and Young Adult Oncology, Cancer and Blood Disorders Centre, Seattle Children's Research Institute, Seattle, Washington, USA
  7. Division of Hematology-Oncology and Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA
  8. Divisions of Palliative Care and Pediatric Hematology/Oncology, University of Nebraska Medical Centre, Omaha, Nebraska, USA
  9. Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Boston, Massachusetts, USA
  10. School of Health Sciences, University of Southampton, Highfield, Southampton, UK
  11. Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
  12. Hematology, Oncology and Transplant Program, Alberta Children's Hospital, Calgary, Alberta, Canada
  13. Queensland Children's Hospital, Brisbane, Queensland, Australia
  14. Children's Health Queensland Critical Unit, Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
  15. Adolescent and Young Adult Cancer Services Team, Canterbury District Health Board, Christchurch, New Zealand
  16. Sydney Children's Hospital, Randwick, NSW, Australia
  17. Palliative Care Service, Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, NSW , Australia
  18. Chris O'Brien Lifehouse Cancer Centre, Camperdown, NSW, Australia
  19. Collaboraide, Brisbane, Queensland, Australia
  20. Population Sciences fo Pediatric Hematology/Oncology, Dana Farber Cancer Institute, Boston, Massachusetts, USA
  21. School of Psychology, The University of New South Wales, Kensington, NSW, Australia
  22. School of Nursing, Midwifery and Health, Coventry University, Coventry, UK
  23. Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, UNSW Sydney, Kensington, NSW, Australia

Aims. For the subset of adolescents and young adults (AYAs) whose cancer cannot be cured, age-appropriate end-of-life discussions are critical. However, health-professionals do not feel confident or adequately-skilled to facilitate these conversations. Data is lacking to inform what kind of targeted training is needed to improve clinical practice in this area. We will describe outcomes from two studies exploring how best to equip health-professionals with the skills to effectively support end-of-life communication with AYAs.

Methods. Both studies used online survey methodology with health-professionals involved in caring for AYAs with cancer. Study 1 examined barriers to end-of-life communication among Australian and New Zealand health-professionals. Study 2 used a modified, two-round Delphi survey with a global health-professional sample to establish (i) the content and format needed in training for this communication, and (ii) feasibility, acceptability, and likelihood of uptake of different training models and modalities internationally.

Results. 105 health-professionals from Australia/NZ participated in Study 1. Participants reported that the greatest barrier to end-of-life communication was not knowing how to introduce the topic, particularly palliative care (67%) and advance care planning (72%). Health-professionals reported that they would find experiential training and workshops most helpful (77% and 75% respectively). Study 2’s global Delphi survey recruited 248 health-professionals across 8 countries. The two topics rated most important to receive training on were appropriately timing end-of-life conversations (M=8.7/10) and AYA relationship-management skills (M=8.6/10). Top barriers to attending training were lack of time (56%) and heavy caseload (49%).

Conclusions. Health-professionals need support to deliver end-of-life communication with AYAs. By identifying barriers to best-practice, and preferences for training in this area, these studies will directly inform the development of sustainable clinician-training resources, including in adult oncology health-settings. Future work will consider team and system-level resourcing factors to be addressed to ensure feasible professional capacity-building models to support best-practice.