Educational Priorities in Oncologic Critical Care: A Modified Delphi Study

BACKGROUND: Advances in cancer diagnosis and treatment have prolonged survival, expanded therapeutic options, and introduced novel treatment-related toxicities. Patients with cancer now account for more than 20% of ICU admissions, exposing intensivists to increasingly complex clinical scenarios. Despite this evolving landscape, oncologic critical care education within PCCM fellowship training remains unstructured, with no consensus on educational priorities or expectations for trainee practice. OBJECTIVES: To define consensus-based educational priorities in oncologic critical care for PCCM fellowship training and clarify expectations regarding trainee management responsibility. METHODS: We conducted a modified Delphi study between October and December 2025. Expert panelists were purposively recruited based on clinical or educational expertise in PCCM, hematology, oncology, and fellowship education. Using a REDCap-based survey, panelists rated 47 proposed topics across 11 oncologic critical care domains for importance to graduating PCCM fellows without additional sub-specialty training. Topics were rated using a four-point scale, with consensus defined a priori as ≥ 70% "Must Know" ratings. Open-ended feedback informed addition of a secondary rating scale in Round 2 assessing expected management responsibility (independent management vs. co-management with Hematology/Oncology). Responses were analyzed descriptively and in aggregate. RESULTS: Of 58 invited experts, 41 (70%) completed Round 1. All Round 1 respondents were invited to participate in Round 2, of whom 32 (78%) completed the survey. Panelists represented diverse disciplines, geographic regions, and levels of experience. Of the 47 topics presented in Round 1, 33 met consensus criteria. Three topics close to consensus were carried forward based on panelist feedback. Five new topics were introduced in Round 2, three of which achieved consensus. In total, 39 topics were retained across both Delphi rounds. Consensus items emphasized core principles of oncologic critical care including ICU triage, procedural safety, management of infectious, metabolic, neurologic and oncologic emergencies, respiratory failure and therapy-related complications. Management-responsibility ratings differentiated topics appropriate for independent PCCM management from those requiring co-management with hematology/oncology. CONCLUSION: This study defines consensus-based educational priorities in oncologic critical care and clarifies expectations for trainee management and interdisciplinary collaboration, providing a practical framework to align PCCM fellowship training with contemporary ICU practice.