Treatment selection in cml: Effect of online education on clinician knowledge and confidence

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.