Lefkowits, Carolyn

Purpose: Palliative care focuses on providing relief from the stress and symptoms of serious illness. Obstetrician gynecologists (OBGYNs) manage a variety of complex clinical situations ranging from delivering a cancer diagnosis to caring for a neonatal demise to symptom management, all of which fall within the realm of palliative care. Palliative care is relevant to the practice of OBGYNs, yet residents rarely receive formal primary palliative care training. We sought to design, implement, and evaluate a dedicated curriculum on palliative care for OBGYN residents. Methods: We performed a needs assessment of an OBGYN residency at a single institution. This information was used to develop a multidisciplinary palliative care curriculum. Post-curriculum surveys were distributed and analyzed. Descriptive statistics were utilized. Results: Our needs assessment identified a lack of knowledge and competency in palliative care concepts and skills. Using this information, we created a multidisciplinary palliative care curriculum, including clinical experiences, chalk talks, and online didactics. Post-curriculum surveys revealed a marked improvement in both knowledge base and perceived competence. Feedback was overwhelmingly positive; residents indicated that the curriculum was both a valuable use of time and would impact their provision of care in the future. Conclusion: A dedicated palliative care curriculum is an impactful addition to OBGYN training.

131 Background: Gynecologic oncologists report a lack of knowledge and comfort with palliative care topics including opioid management, despite their clinical importance. The objective of this study is to evaluate the impact of an online opioid educational module among gynecologic oncologists. Methods: A 25-minute video module was developed to provide an overview and example cases for opioid initiation, titration, and conversion. Fellows and early career gynecologic oncologists were invited to participate in a 24-question online survey addressing demographics, palliative care education in training, and preparedness and opioid-related knowledge. After viewing the module, participants completed a post-intervention survey, which was comprised of the same six knowledge-based questions and an assessment of the module. Responses were anonymous. A 3 month follow up survey will be sent to assess knowledge retention. Results: A total of 38 participants completed the initial and post-module survey, including 14 residents, 12 fellows, and 12 candidate members. Nineteen (50%) respondents had been previously taught to calculate a 24-hour oral morphine equivalent (OME) and to titrate opioids, but only 7 (18%) had received formal teaching on opioid rotation. Twenty four (63%) participants rated the quality of teaching overall in their fellowship as good, very good, or excellent, but only 15 (39%) rated palliative care education as at least good. Eleven (30%) respondents had a palliative care rotation in fellowship. Knowledge scores improved from pre-module to post-module, 49.5% correct answers compared to 74.6% (p<0.001). Thirty five (92%) of respondents were satisfied or very satisfied with this module and are interested in additional palliative care modules. Conclusions: A single online palliative care education module was associated with significantly improved participant knowledge on opioid management. Over 90% of respondents were satisfied with the module demonstrating an opportunity for improvement in palliative care education in gynecologic oncology via online education.

29 Background: Good communication is crucial to good patient care. Gynecologic oncology providers often face challenging communication scenarios, including giving serious news and discussing goals of care. Communication skills training (CST) has been shown to improve skill acquisition among providers of multiple specialties, but it has not been described in providers from gynecologic oncology or any surgical oncology specialty. Methods: We conducted a two-day CST workshop, based on the VitalTalk© model, with four faculty members (2 gynecologic oncologists and 2 palliative care physicians) and 10 gynecologic oncology provider participants (5 fellows and 5 advanced practice providers). Using didactics, demonstrations and practice sessions with simulated patients we focused on giving serious news and discussing goals of care. Pre and immediate post-workshop surveys evaluated acceptability of the workshop, perceived impact of preparedness to address challenging communication scenarios and anticipated impact on clinical practice. We compared pre and post-workshop prevalence of score of 4 or 5 out of 5 on a Likert scale for preparedness to handle 14 challenging communication scenarios. Results: Participants reported statistically significant increase in preparedness to handle 13 out of 14 challenging communication scenarios. Among those 13 topics, magnitude of improvement in proportion of participants rating preparedness 4 or 5 out of 5 ranged from 40-100% (all p < 0.05). All participants would recommend the course to others and all strongly agreed that this training should be required of all gynecologic oncology clinicians. Conclusions: Participants felt strongly that the workshop provided high quality education relevant to their practice. As a result of the workshop, participants reported statistically significantly increased preparedness to handle challenging communication scenarios. CST is feasible and has high perceived effectiveness for clinicians in the primarily surgical oncologic specialty of gynecologic oncology.