Defining Outpatient Curricular Content for Hospice and Palliative Medicine Trainees: A National Survey

Key Message: This national survey of U.S. outpatient palliative care (PC) clinicians identified and prioritized a list of outpatient-focused didactics important for ambulatory PC practice. This ranked list informs the development of outpatient-focused PC curricula and educational resources for hospice and palliative medicine fellows and clinicians new to ambulatory PC practice.

Abstract:

Background: Strong evidence supports the benefits of longitudinal outpatient palliative care (PC). Yet, access to outpatient PC lags behind inpatient PC, partly due to a shortage of skilled outpatient clinicians to meet demand (1,2). Hospice and palliative medicine (HPM) educational leaders report that fellows receive lower-quality education and less preparation for ambulatory practice (3). Lack of literature and consensus on core outpatient-specific knowledge and skills has limited the development of curricula to improve outpatient PC training (3,4,5).

Methods: We conducted a national survey of United States outpatient PC clinicians (physicians, advanced practice providers (APPs)) to identify and prioritize ambulatory-focused didactics topics. A list of 51 topics was drawn from existing PC competencies and refined through expert input. Respondents selected up to 20 topics learners should receive during training.

Results: Of 247 clinicians, 136 responded (55%), including 115 physicians and 21 APPs, with representation across all US regions. Nearly 60% of respondents had 5+ years of outpatient PC experience, and half reported 4+ half-day clinic sessions per week. Of 51 topics, eight were selected by more than 50% of respondents. Four emphasized distinct outpatient application of core PC skills—pain, non-pain symptoms, depression and anxiety, and goals of care. The remaining four were topics related to longitudinal pain and opioid management, including opioid safety, opioid de-escalation, and best practices when caring for patients with co-morbid pain and substance use disorder. An additional 12 topics, including assessing and supporting coping, medical cannabis, and inter-visit skills (inbox management, telephone triage, navigating early refill requests), were selected by 40-50% of respondents.

Implications: This national survey identifies outpatient-focused didactic topics prioritized by practicing outpatient PC clinicians. This ranked list offers educational leaders a framework to evaluate and strengthen outpatient curricula and informs the development of educational resources to better support clinicians’ training for outpatient PC practice.

References: 1) Hui D, De La Rosa A, Chen J et al. “State of Palliative Care Services at US Cancer Centers: An Updated National Survey.” Cancer 2020; 126 (9): 2013–23.

2) Rosenblum RE, Rogal SS, Park ER et al. “National Survey Using CFIR to Assess Early Outpatient Specialty Palliative Care Implementation.” Journal of Pain and Symptom Management 2023; 65 (3): e175–80.

3) Han HJ., Ouellette MC, Yeh JC et al. “Outpatient Training during Hospice and Palliative Medicine Fellowship: A National Survey.” Journal of Pain and Symptom Management 2024; 68 (4): 340–51.

4) Dahlin C and Wright PM. “A Survey of Current Specialty Palliative Care Education in the United States.” Annals of Palliative Medicine 2024;13 (4): 1035–46.

5) Finlay EE, Goodlev ER, Biewald MA, Skavinski KA, Sinclair CT. “An Educational Needs Assessment for Outpatient Palliative Care Clinicians.” Journal of Palliative Medicine 2023;26 (4): 464–71.