Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice?

Caitlin S Haxel; Abigail H Belser; Michael DeSarno; Julie Glickstein; Jonathan N Flyer

doi:10.1016/j.jpainsymman.2023.06.001

Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice?

J Pain Symptom Manage. 2023 Sep;66(3):e343-e352. doi: 10.1016/j.jpainsymman.2023.06.001. Epub 2023 Jun 15.

Authors

Caitlin S Haxel¹, Abigail H Belser², Michael DeSarno³, Julie Glickstein⁴, Jonathan N Flyer⁵

Affiliations

¹ Department of Pediatric (C.S.H, J.N.F.), The Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT; Division of Pediatric Cardiology (C.S.H.), University of Vermont Children's Hospital, Burlington, VT, USA. Electronic address: Caitlin.Haxel@uvmhealth.org.
² Boston Combined Residency Program (A.H.B.), Boston Children's Hospital, Boston, MA, USA.
³ Department of Medical Biostatistics (M.D.), The Robert Larner M.D. College of Medicine at the University of Vermont, Colchester, VT, USA.
⁴ Department of Pediatrics, Division of Pediatric Cardiology (J.G.), Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA.
⁵ Department of Pediatric (C.S.H, J.N.F.), The Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT; Division of Pediatric Cardiology (C.S.H.), University of Vermont Children's Hospital, Burlington, VT, USA.

PMID: 37327916
DOI: 10.1016/j.jpainsymman.2023.06.001

Abstract

Context: Condolence letter (CL) writing after the death of a child is an important opportunity for humanism. Pediatric cardiology fellowship training now recognizes the importance of palliative care, but rarely includes CL education, despite its fragile patient population.

Objectives: To address this professionalism gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship. This study investigated the impact of the curriculum on pediatric cardiology CL writing, and broader CL practices and beliefs.

Methods: Pediatric cardiology fellows at a high volume urban academic program from 2000 to 2022 were divided into two cohorts (exposure to CL curriculum [2014-2022] vs. no exposure [2000-2013]) and responded by anonymous electronic multiple choice and open ended survey to assess the CL curriculum and describe current CL practices and beliefs. Impact of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence were utilized for group comparisons.

Results: The overall survey response rate was 59% (63/107). Cardiologists who participated in the curriculum (64%, 35/55) were more likely to report writing CLs (80% vs. 40%; P < 0.01). Impactful curriculum elements included the opportunity for all fellows to contribute to a CL (78%) and identifying a primary fellow to write the CL (66%). A majority (>75%) of curriculum participants agreed that formal teaching increased their frequency, ability, and comfort in writing CLs.

Conclusion: Development of condolence expression educational programs in pediatric cardiology training should be expanded.

Keywords: Palliative care; condolence letter; educational curriculum; pediatric cardiology.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiology* / education
Child
Curriculum
Education, Medical, Graduate
Fellowships and Scholarships*
Humans
Needs Assessment
Surveys and Questionnaires