Implementation of Structured Oncologist Communication Skills Training within the Improving Goal Concordant Care Initiative: Lessons Learned and Future Progress

Abstract

Purpose:

Effective communication about goals of care is critical in oncology but limited by insufficient training and system barriers. As part of a multicomponent intervention, the Improving Goal Concordant Care (IGCC) initiative aimed to implement structured communication skills training (CST) for oncology clinicians. This study reports on the implementation and evaluation of CST across 10 dedicated cancer centers.

Patients and Methods:

IGCC was a collaborative improvement project led by the Alliance of Dedicated Cancer Centers between 2020 and 2023. Centers selected or developed CST programs meeting IGCC criteria and adapted local implementation and enabling strategies. The primary measure was the percentage of eligible oncology clinicians completing CST (target ≥65%). Post-training evaluation and training impact surveys assessed clinicians’ experience and perceived benefit of CST.

Results:

Nine centers completed CST implementation, training 2271 of 2841 eligible clinicians (80%). CST completion rates at all but one site exceeded the target, as did rates for medical oncologists, hematological oncologists, and advanced practice providers. CST completion was higher when incentives or mandates were used. Post-training evaluations showed high satisfaction with aggregated top-box scores of 93% for training quality, 94% for recommending to colleagues, and 94% for likelihood to use skills. Training impact surveys administered 6–12 months after training suggested improved self-efficacy and reduced distress, with a strong correlation between self-efficacy improvement and distress reduction.

Conclusions:

IGCC demonstrated that CST can be effectively scaled across cancer centers and positively impact trained clinicians. Successful uptake was supported by leadership engagement, incentives, and mandates, while barriers included leadership transitions, time and resource constraints, and competing priorities. CST is a core component for advancing goal-concordant care.