Addressing Challenges in Chronic Phase Chronic Myeloid Leukemia: Impact of Education on Practice Behaviors and Knowledge

Background: Optimal outcomes for patients with chronic-phase chronic myeloid leukemia (CML) require both rigorous patient adherence to oral tyrosine kinase inhibitor (TKI) therapy and regular monitoring of treatment response by clinicians. Clinicians caring for patients with CML face a number of challenges with respect to management including selecting initial therapy, monitoring for treatment resistance and failure, and determining when to switch therapy. As a result of barriers including lack of time to search guidelines and lack of experience with CML, analyses have demonstrated that adherence to management guidelines, such as those of the European LeukemiaNet and National Comprehensive Cancer Network, is poor (Goldberg SL, et al. J Oncol Pract. 2015;11:e398-e404; Guérin A, et al. Curr Med Res Opin . 2014;30:1345-1352). To address these challenges, we created an education activity focused on molecular profiling, treatment selection, and management of treatment outcomes. Learner responses were evaluated to assess the influence of education.

Methods: A live-online 1-hour video continuing medical education activity with slides, polling and live questions was launched on October 27, 2016 and made available on-demand at www.OMedLive.com through October 27, 2017. CME test questions were administered at 3 time points (pre-activity, immediate post-activity, and after 8-weeks). Data from these test questions, live polling responses, and questions that learners posed during live Q&A were analyzed to determine engagement, lessons learned, and continuing education gaps. Tests of statistical significance were conducted using the McNemar test for matched pairs (learners who completed both pre/post & pre/survey, respectively). Effect size was computed using Cohen's d (for all significant findings).

Results: Forty-five of 149 (30%) registered learners completed all pre-, post-, and 8-week follow-up surveys, of whom, 71% reported the educational activity positively influenced patient experience or outcome, and 76% reported it positively altered their clinical practice. Learners reported improvements in their ability to assess the relative safety, efficacy and tolerability profiles of TKIs used to treat CML (69%), manage potential adverse events that may be associated with TKI therapies in patients with CML (67%), educate patients on the recent improvements and benefits of existing therapies with respect to survival outcomes (60%), and follow recommendations from clinical practice guidelines on CML (64%). As the result of education, 95 of 149 (64%) of learners reported commitments to change in regards to: medical/practice knowledge (88%), care attitudes (84%), practice behavior (84%) and patient clinical outcomes (79%). Learners demonstrated improved competence via a case scenario which required identifying the optimal next step for a 61-year old patient with CML who was not meeting treatment milestones. They also showed improved knowledge on the efficacy of specific TKIs in newly diagnosed CML patients, the definition of a complete cytogenetic response, and use of molecular profiling and influence of molecular response on prognosis. Although this study is limited by lack of access to practice data, outcomes results and participant questions indicate clinicians may benefit from continuing education on CML.

Conclusions: Ongoing education on CML can yield immediate and sustained gains in knowledge, competence, and performance, which may improve adherence to guidelines and outcomes for patients.