Implementation of Communication Skills Training at Oncology Centers in Germany: Results of a Mixed-Methods Survey.

Introduction
The concept of oncological communication skills training (CST) has already proven to be effective and has been incorporated into the relevant guidelines. The current status of CSTs in Germany is unclear.Methods
We approached all oncology centers in Germany certified by Deutsche Krebsgesellschaft (DKG) and investigated quantitative and qualitative aspects of CST programs in a mixed-methods approach using questionnaires and interviews.Results
Only a quarter (23.7%, n = 18/76) of the responding centers demonstrated a regular CST. These CSTs were partially congruent with the consensus recommendations while deviating significantly in other areas, such as duration, scope, and course content. We asked centers that do not offer CST or do not offer fully satisfactory CST (respondents n = 60) for factors that hinder successful implementation, which were identified as, e.g., scarce time and personnel resources (92%), no counterpart funding (27%), lack of appreciation (25%) and knowledge about the concept (3%), organizational obstacles (22%), and low prioritization (12%). Steps that could facilitate nationwide implementation were found, such as support for implementation through concrete instructions (27%), mandatory participation (20%), an active management level in the question of responsibility (17%), inclusion in the certification criteria for oncology centers (12%), and an integration into the Weiterbildungsordnung (WBO, specialist training guideline) (10%).Conclusion
Although previous studies have shown that CSTs have positive effects, sufficient implementation has not yet been achieved across the board in Germany. Individual starting points have been identified; further efforts are needed to advance this goal.