Knowledge and Preferences of Primary Care Providers in Delivering Head and Neck Cancer Survivorship Care.

Long-term care for head and neck cancer (HNC) survivors is complex and requires coordination among multiple providers. Clinical practice guidelines highlight the role of primary care providers (PCPs) in screening for secondary cancer/recurrence, assessment of late/long-term side effects, and referrals for appropriate specialty management of toxicity. However, these responsibilities may be difficult to meet within the scope of primary care practice. We conducted this study to explore preferences, comfort, and knowledge of PCPs in the care of HNC survivors. We piloted a 40-item web-based survey developed with oncologist and PCP input targeted for family medicine and internal medicine providers. Responses were collected within a single university health system over 2 months. PCPs (n = 28; RR = 11.3%) were interested in learning about health promotion after cancer treatment (89%) and generally agree that their current practice patterns address healthy lifestyle behaviors (82%). However, only 32% of PCPs felt confident they could manage late/long-term side effects of chemotherapy, radiation, or surgery. Only 29% felt confident they could provide appropriate cancer screening. Looking at shared care responsibilities with oncology providers, PCPs perceived being responsible for 30% of care in the first year after treatment and 81% of care after 5 years. Seventy-one percent of PCPs agreed that oncologists provided them necessary information, yet 32% of PCPs found it difficult to coordinate with cancer providers. While these PCPs perceive increased care responsibility for long-term survivors, most are uncomfortable screening for recurrence and managing late/long-term side effects. Education and mutual coordination between PCPs and oncology providers may improve survivor care.

Design and pilot test of an implicit bias mitigation curriculum for clinicians.

Introduction: Clinician implicit racial bias (IB) may lead to lower quality care and adverse health outcomes for Black patients. Educational efforts to train clinicians to mitigate IB vary widely and have insufficient evidence of impact. We developed and pilot-tested an evidence-based clinician IB curriculum, "REACHing Equity." Methods: To assess acceptability and feasibility, we conducted an uncontrolled one-arm pilot trial with post-intervention assessments. REACHing Equity is designed for clinicians to: (1) acquire knowledge about IB and its impact on healthcare, (2) increase awareness of one's own capacity for IB, and (3) develop skills to mitigate IB in the clinical encounter. We delivered REACHing Equity virtually in three facilitated, interactive sessions over 7-9 weeks. Participants were health care providers who completed baseline and end-of-study evaluation surveys. Results: Of approximately 1,592 clinicians invited, 37 participated, of whom 29 self-identified as women and 24 as non-Hispanic White. Attendance averaged 90% per session; 78% attended all 3 sessions. Response rate for evaluation surveys was 67%. Most respondents agreed or strongly agreed that the curriculum objectives were met, and that REACHing Equity equipped them to mitigate the impact of implicit bias in clinical care. Participants consistently reported higher self-efficacy for mitigating IB after compared to before completing the curriculum. Conclusions: Despite apparent barriers to clinician participation, we demonstrated feasibility and acceptability of the REACHing Equity intervention. Further research is needed to develop objective measures of uptake and clinician skill, test the impact of REACHing Equity on clinically relevant outcomes, and refine the curriculum for uptake and dissemination.ClinicalTrials.gov ID: NCT03415308.

The Implementation of Communication Didactics for OB/GYN Residents on the Disclosure of Adverse Perioperative Events.

OBJECTIVE: Communication skills are key components of the patient-physician relationship, yet are not routinely taught during residency. Institutional data demonstrates 75% of residents regularly encounter difficult communication scenarios. This study's objective is to develop and pilot a communications didactic/skills training program for Obstetrics & Gynecology (OB/GYN) residents focused on the disclosure of adverse perioperative events. DESIGN: This was an observational, prospective cohort pilot study. OB/GYN residents completed a 4-hour interactive curriculum using VitalTalk methodology, certified facilitators, and simulated patients in 2019. Participants completed self-assessments of their skill levels at 3 time points: prior to training, immediately post-training, 3-month post-training. Wilcoxon signed rank tests were used to evaluate change in skill levels. SETTING: University-based program in North Carolina. PARTICIPANTS: Participants included all OB/GYN residents from postgraduate years 1-4. Out of 31 residents, 27 participated in the training, 24 completed the immediately post-training survey, and 23 completed the 3-month post-training survey. RESULTS: At baseline, most residents rated their global skill level in communication as novice (37.0%) or advanced beginner (33.3%). Immediately following the intervention, 41.7% of residents ranked their global skill as "competent" and 20.8% as "proficient." These changes were statistically significant (p < 0.001). Notable improvements were seen across multiple variables, including the handling of emotional reactions (p = 0.046). No significant changes were noted between the immediately post-training and 3-month time points, suggesting skill retention. Majority of trainees (78.3%) felt that refresher courses would be useful for skill maintenance. CONCLUSION: A simulation-based formalized communication curriculum is effective for improving OB/GYN resident competence and skill levels in the disclosure of adverse perioperative events. Specific to adverse surgical complications, this curriculum appears feasible for implementation by other training programs. Further work is needed to identify the most beneficial timing and modality of these workshops.

Head and Neck Cancer Survivors: Specific Needs and Their Implications for Survivorship Care Planning.

BACKGROUND: Head and neck cancer (HNC) survivors experience significant sequelae of treatment, including long-term physical side effects and ongoing cancer surveillance. OBJECTIVES: The aim of this study is to understand patients' survivorship knowledge gaps and supportive care needs. METHODS: Through an anonymous cross-sectional survey, the authors evaluated 41 HNC survivors' knowledge regarding post-treatment issues. FINDINGS: Patients had undergone a variety of treatment modalities.