ABSTRACT
Background: BCMA-directed modalities including CAR T-cell therapy, bispecific antibodies and antibody-directed cytotoxic agents are potentially transformative next steps in managing patients with multiple myeloma. However, beyond expert centres physicians have little experience of such agents to date. Aims: This study aimed to determine whether online continuing medical education could improve the knowledge and confidence of clinicians in their understanding of the rationale for and clinical aspects of different BCMA-directed therapies Methods: Three educational activities were launched for physicians outside the USA during 2020 to a target audience of hematologist/oncologists and ophthalmologists. Activities comprised a 30-minute video lecture, a 15-minute video collegial discussion, and a 30-minute online video panel discussion. Data were collected March to June 2020. For each activity educational effect was assessed with repeated-pairs pre-/ post-activity, where individual participants served as their own control. 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed. Data were subsequently combined and analyzed to provide a summative overview of the effect of the education across the combined knowledge-based learning objectives and confidence questions from the three programs. A McNemar's test was conducted to assess statistical significance of changes from pre- to post-assessment. Results: Between 66 and 103 hematologist/oncologists (combined total n=259) and 39-41 ophthalmologists (combined total n=121) completed pre- and post-activity questions. A statistically significant effect was observed for hematologist/oncologists across all 3 learning objectives (P<0.05-P<0.001) with a relative improvement in % of correct responses ranging from 10-44%. Furthermore, there was an overall improvement in confidence, with a 72% gain in confidence in those reporting increased confidence. The education had less impact on ophthalmologists;while some improvements were noted in individual activities, in the summative overview the greatest improvement was noted in knowledge of AEs associated with BCMA-directed therapies. The summative overview revealed that hematologists/oncologists demonstrated improvements in knowledge across the 3 learning objectives: 10% (P<0.05) regarding rationale and types of BCMA-directed therapies, 44% (P<0.001) regarding AEs associated with BCMAdirected therapies, and 29% (P<0.001) regarding BCMA clinical trials data. Ophthalmologists showed knowledge changes of -2% (NS) regarding knowledge of clinical data and the rationale and type of BCMA-directed therapy, and a 41% (P<0.05) improvement in knowledge of BMCA-therapy associated AEs. In combined self-assessed confidence questions, 51% of hematologist/oncologists had a measurable increase in and 46% maintained confidence. Thirty-three percent of ophthalmologists had a measurable increase in and 59% maintained confidence. All changes in confidence were significant (P<0.01 or P<0.001). At the individual activity level, ~50% of all participants stated that they would modify treatment plans and ~90% were committed to those changes. Summary/Conclusion: These three educational activities resulted in a considerable educational impact, particularly for hematologist/oncologists. Online medical education is valuable in improving knowledge and confidence, as well as identifying areas of continued educational need and potentially improving patient outcomes, of particular importance during the COVID-19 pandemic where in-person conference learning is inaccessible.
ABSTRACT
Background: Despite the improvement in patient outcomes with the implementation of TKIs, patients still relapse on or are intolerant of initial treatment and an associated impact on quality of life. Physician choice of 2nd and 3rd line treatment is currently essentially limited to the same TKIs as are available for front-line treatment, with the exception of ponatinib. Thus physician's choice of 2nd or 3rd line therapy is not only predicated on patient disease, social and clinical characteristics, but also by which TKI the patient received previously, challenging them to make choices from a decreasing pool of options. Aims: This study determined whether online continuing medical education could improve the knowledge and confidence of clinicians in best-practice sequencing strategies for patients with CML after front line therapy with a tyrosine kinase inhibitor (TKI), using a case-based approach. Methods: A 30-minute online video panel discussion was launched for countries outside the USA in June 2020. Data were collected to September 2020. Educational effect assessed with repeated-pairs pre-/ post-activity, where individual participants served as their own control. 3 multiple-choice, knowledge questions and 1 self-efficacy, 5-point Likert scale confidence question were analyzed. Chi-squared test assessed pre- to post-activity change (5% significance level, P <.05). Magnitude of change in total number of correct responses overall, and for each question, were determined with Cramer's V (<.06=Modest, 0.06- 0.15=Noticeable, .16-.26=Considerable, >.26=Extensive). Results: 52 hematologist/oncologists completed pre- and post-activity questions. A considerable educational effect was observed (V=.181, P<.0001) with average % of correct responses increasing from 34 to 52%. Clinicians with 3/3 answers correct increased post-activity (4 to 12%) and for 2/3 answers correct post-activity (29-46%). Improvements in % of correct responses post-activity were seen for questions on: the patient population with the best outcomes related to clinical trials data, the application of the ELN guideline recommendations for defining response to TKI treatment, and the selection of an appropriate alternative TKI for a patient case (relative improvements, 25%, 56%, and 85%). 52% of haematologist/oncologist responses were improved or reinforced post-activity. 48% of all participants stated they would modify treatment plans. 31% had a measurable increase in confidence in selecting an appropriate BCR-ABL TKI for individual patients with CML who have failed prior lines of therapy with a total average confidence shift of 9.6%. Summary/Conclusion: This on-demand, online video panel discussion resulted in a considerable educational impact. Online medical education is valuable in improving knowledge and confidence, as well as identifying areas of continued educational need and potentially improving patient outcomes, of particular importance during the COVID-19 pandemic where in-person conference learning is inaccessible.