PM2017: Condolence Letter Writing in Pediatric Cardiology: How Does a Fellowship Curriculum Impact Post-graduate Condolence Letter Writing Practices?

Background: Although writing a condolence letter (CL) after the death of a child is an important opportunity for humanism in pediatrics, cardiology fellowship training rarely includes standardized CL education. To address this professional gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship during 2013-2014. Key condolence education program elements include an annual lecture, a structured fellowship communication process, and professional behavior modeling by senior physician leadership.

Methods: This study assessed the efficacy of a single center pediatric cardiology fellowship educational program at an academic cardiothoracic surgical center. Secondary aims were to evaluate pediatric cardiologist practices and beliefs regarding the importance of writing CLs. Pediatric cardiology trainees from years 2000 to 2022 responded by anonymous electronic survey (March 2022) to assess the fellowship CL curriculum and describe current CL practices and beliefs. Effectiveness of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence, with significant level alpha set a priori at 0.05, were utilized for group comparisons (CL fellowship education exposure vs non).

Results: The survey response rate was 50% (54/107). Cardiologists who self-identified participation in the fellowship CL writing curriculum (32/48, 67%) are more likely to report writing CLs (81% vs 50%; p=0.03). The most impactful curriculum elements include the opportunity for all fellows to contribute to a CL (77%), identifying a primary fellow to write the CL (67%), and providing a CL writing framework (60%) (Figure 1A). Of curriculum participants, ≥80% somewhat to strongly agree that the educational exposure increased their frequency, ability, and comfort in writing CLs (Figure 1B). Nearly 71% of responding cardiologists report writing CLs in current practice. While 97% report beliefs that CLs positively impact families, and 94% believe not sending CLs conveys a lack of concern, only 51% report always writing CLs (Figure 2). For those who write CLs, 89% do so as an opportunity to express sympathy to the family, and 69% as an important contribution to patient care. Only 3% report writing CLs due to family expectations or to prevent medical-legal issues. Nearly all cardiologists reported writing CLs after the loss of a child/adolescent (92%) or neonate/infant (86%) with congenital heart disease, compared to fetal cardiac diagnoses and subsequent termination of a pregnancy (14%) or intrauterine fetal demise (11%), and loss of an adult with congenital heart disease (11%).

Conclusion: Pediatric cardiology fellowship CL writing curriculum participants report increased frequency, ability, and comfort writing CLs. Pediatric cardiologists interpret CL writing to have a positive impact on families, and as opportunities to express sympathy. Further development of CL educational programs in pediatric cardiology training, inclusive of prenatal and adult congenital populations, should be considered.