“I’ve noticed that [we are] not training fellows on how to talk to patients about clinical trials. Even if there isn’t a clinical trial available for them right now, just talking about it as a way to receive treatment [is important]. We thought of this [program] from an equity [point of view]; we should be talking to all patients about clinical trials,” Bylund said in an interview with Oncology Fellows.
Bylund is the associate chair of Education in the Department of Health Outcomes and Biomedical Informatics, the assistant director of the Cancer Training and Education Program, and a professor at the University of Florida Health Cancer Center in Gainesville.
In the interview, Bylund discussed the design of the program, the results of its implementation, and future directions for research into this area.
Oncology Fellows: What is the current standing of clinical trial communication skills training for hematology/oncology fellows and what prompted the initiation of this project?
Bylund: We did some formative research where we found that [clinical trial communication] is not being taught in [all] hematology/oncology fellowship programs. If it’s being taught, it’s just at specific programs; no national program is doing this. We also did a needs assessment with program directors across the country [to assess] if this is something they’d be interested in if we developed a program for this.
We based the program itself on what we know about communication skills training in medicine. A lot of work has been done on this topic over many years. We start training medical students on how they should communicate with patients during residency and fellowship. There’s also communication training for practicing providers in oncology.
We know that there needs to be some sort of conceptual framework for good communication skills training. We need to give [trainees] a framework of what it is we’re teaching them to do and show them good examples of how to do it. We also need to give them a chance to try it out.
Our program is based on those fundamental approaches.1 It’s a 3-hour program. In the first hour, we have an interactive didactic session where we talk about current problems with retention to clinical trials and how [patient] communication can help us overcome those problems. We [then] introduced the COMM-CCT framework, which is a model that trainees can rely on when they’re having a conversation with a patient about a trial, and then we give them some information about helping their patients find trials. This is all done on Zoom because we’re doing it nationwide.
For the remaining 2 hours of the course, we break the fellows up into small groups and we have patients who’ve had diagnoses of blood cancer come on and role play characters. The fellows can practice talking about clinical trials and try out new things that they haven’t done before. Everybody gets a chance to role play and then we discuss [the conversation] to get the fellows’ feedback. At the end, those [individuals] who played the role of our patients unmask themselves and they talk with the group about who they are, what their experience was with blood cancer, and what clinical trials they’ve been on.
What were the key findings from the program that you presented during the 2025 ASCO Annual Meeting?
Our presentation at the 2025 American Society of Clinical Oncology [ASCO] Annual Meeting was focused on the implementation of the program. Can we get [other fellowship] programs to do this? What do the fellows think about it? Do they find it acceptable? We’ve also collected other data that we’re analyzing looking at the changes that the program has made in behavior, knowledge, and attitudes. We are following up with the fellows over a 6-month period. We’re going to be presenting that portion of the data at the 67th American Society of Hematology Annual Meeting and Exposition.
We have good evidence to show that this workshop is feasible, acceptable, and that it’s changing behavior, attitudes, and knowledge. We are now working on disseminating the program because we want to push it out to as many programs as possible. Over the next 2 years, we are [going to] implement this program at 16 fellowship programs across the country. This is free-of-charge to the fellowship programs.
We were happy with the feasibility of this. The results that we presented at ASCO were based on a course evaluation that we gave to the participants, and they rated it highly. We also did interviews with a subset of the fellows so that we could get mixed-methods data that allow us to have a bit more depth and understanding.
One of the things that we learned from those data is that we helped them feel like they didn’t have to know every little thing about the trial to talk with patients about it. Their job is not to consent the patient. Their job is to introduce the idea of trials, to talk with the patient in generalities about what the trial is, and then, if the patient is interested, to move them on to the research coordinator or team to talk in more detail about consent and to make sure the patient is eligible. This is an important approach that we want to take in our teaching. We want to help the fellows feel like it’s okay to talk about trials, even if they don’t have every single answer.
The means acceptability [levels] were high; they were in the 4 to 5 range [out of 5]. [The fellows noted] how useful the role-playing aspect was. Usually, when you tell [trainees] they have to role-play, they’re not very excited. But after they did it, they talked about how great it was to get feedback, to see their colleagues [act out scenarios], and to have real patients [to converse with].
What is the most important piece of advice you’d want to impart on fellows in terms of how to effectively communicate about clinical trials with patients?
We are trying to normalize clinical trials as a quality treatment option, not just what you do as a last resort. Patients get very good care when they go on a clinical trial, even if they don’t get randomly assigned to [the drug] that’s being tested. [We want] to help the [fellows] talk about [clinical trials] in a way that hopefully helps reframe them for patients: they’re receiving treatment, but they’re receiving it through a clinical trial.
One of the skills that we teach the fellows is that when they first go in [to see a patient], before they even talk about treatment options, they [create] an outline. When they outline options, [they know] that they can use a standard treatment or treatment through a clinical trial. Even if there isn’t a trial for a patient right now, maybe in the future there will be. From the very beginning, they’re normalizing clinical trials as a way to receive treatment. That shift in the way we talk about [clinical trials] is important.
What are your plans for this program and research area?
There are [over] 150 hematology/oncology fellowship programs [in the US].2 [It makes us] question ‘Who else could we be teaching this to?’ Surgical oncology, radiation oncology, pediatric oncology; there’s a huge audience for this kind of work, and we are discussing ways to make this more scalable. We love doing it real time, via Zoom, [but] we’re not going to be able to reach everybody that way. Are there ways that we can use new technologies?
We are trying to develop standardized patient avatars so [fellows] can practice their communication skills in an asynchronous setting. Are there some other things that we can do to reach everybody? My big goal would be to get this training integrated into fellowship programs across the country. How to talk about clinical trials [with patients] would be part of a fellowship training.
This work is so important [because] fellows are not yet set in their ways. They’re still learning. They have some experience seeing patients, [and] these are [skills] that they can put to use right away. An oncologist is going to see a lot of patients over their career. If we can train [fellows] early in doing this, think about the [effect] that they can have on patients over time.
References
- Bylund C, Parker ND, Lavender L, et al. Implementation of clinical trial communication skills training for oncology fellows. J Clin Oncol. 2025;43(suppl 16):9026. doi:10.1200/JCO.2025.43.16_suppl.9026
- Shahzad M, Basharat A, Javed MJ, et al. “Unveiling the Competition” comprehensive analysis of hematology and oncology fellowship trends through Nrmp data (2011-2024) in United States (US). Blood. 2024;144(suppl 1):7947. doi:10.1182/blood-2024-200180
