A whole-process management intervention to transform pessimistic attitudes toward cancer care among internal medicine residents.

BACKGROUND

In China, improved cancer survival contrasts with persistent pessimistic attitudes among clinicians, which impacts care quality. We developed a "Whole-Process Management" (WPM) training program to bridge this gap by reshaping internal medicine residents' understanding of the cancer care continuum.

OBJECTIVE

To investigate whether a WPM clinical training strategy can transform pessimistic attitudes toward cancer care and foster a more integrated understanding of palliative therapy among internal medicine residents.

DESIGN

A pre-post study utilizing semi-structured interviews. Responses were coded using a predefined categorical framework (positive/negative/NA) and compared before versus after the intervention to characterize internal medicine residents' attitudinal shifts regarding cancer curability, treatment toxicity, and the role of palliative care within the cancer care continuum.

METHODS

Fifty-seven junior internal medicine residents undergoing oncology rotation at a university-affiliated hospital (January 2022-January 2023) received the WPM intervention. This novel training employed longitudinal patient case tracking and structured reflective seminars to help internal medicine residents view cancer as a chronic condition that can be actively managed.

RESULTS

The WPM program significantly reduced pessimistic attitudes. Internal medicine residents recognizing patients in good physical condition increased from 26% to 81% (p < 0.001). Perceptions of treatment toxicity (53% vs 4%), ineffectiveness (75% vs 4%), and expense (84% vs 7%) substantially decreased (all p < 0.001). Awareness of tumor curability improved from 5% to 79% (p < 0.001). The program also improved attitudes toward palliative care: understanding of hospice care principles increased from 0% to 75% (p < 0.001), willingness to consider hospice care for terminal patients rose from 21% to 84% (p < 0.001), and willingness to prescribe opioid analgesics increased from 9% to 93% (p < 0.001).

CONCLUSION

The WPM clinical training strategy effectively addresses pessimistic attitudes by transforming internal medicine residents' clinical perspective from isolated tasks to the patient's entire journey, thereby enhancing their ability to provide integrated palliative and anti-cancer care.