Adaptive learning to address gaps in metastatic breast cancer treatment with CDK 4/6 inhibitors.

Abstract

92 Background: To address identified gaps in knowledge and confidence of US-based healthcare professionals (HCPs) when using cyclin-dependent kinase 4/6 inhibitors (CDK 4/6i) to treat metastatic breast cancer (mBC), an adaptive learning program (ALP) was deployed to review guideline recommendations and evidence from randomized clinical trials (RCTs) and real-world data (RWD). Methods: The ALP consisted of reading materials (guideline excerpts, RCTs, RWD, cases) with a virtual tutor that taught. The ALP continued to review necessary content until responders were both correct and confident (conscious competence). Impact on learning was interpreted as greater for learning objectives with the lowest accuracy score (% of correct responses) and higher distance to 100% conscious competency at baseline. Immediately post-ALP, satisfaction, perceived impact on knowledge, confidence and intent to change practice were assessed quantitatively and qualitatively. ANOVA compared continuous measures by profession. Results: Participants (n=261) were physicians (MD, 17%), advanced practice practitioners (APP, 20%), registered nurses (RN, 49%), pharmacists (11%), and other (3%). Mean completion time was 44 minutes and learners’ proficiency shifted +64% towards conscious competency. The learning objectives most impacted by the education are shown (Table). Learners most satisfied with the ALP (47% with 9-10 on a 10-point satisfaction scale) appreciated the challenge and reported positive impact on their knowledge and confidence, resulting in intent to change their patient-communication, clinical decisions and interprofessional collaboration when using CDK4/6i. Conclusions: This ALP initiative addressed the educational gaps of US HCPs regarding CDK4/6i in HR+/HER2- mBC by challenging participants to re-consider their knowledge and confidence until conscious competency was demonstrated. Engaged learners found the activity impactful and reported intent to change practice. Future studies should seek to address attrition challenges and assess long term impacts of such programs. Top five learning objectives with lowest-ranking accuracy, by profession. Learning Objectives (LOs) Most Impacted Initial Scores by Profession Final Score ALL MD APP RN PharmD Other Identify appropriate CDK4/6i treatment options for a premenopausal woman with newly diagnosed HR+/HER2- mBC 54 57 53 53 62 52 100 Match RWD sources with their characteristics 56 55 60 55 61 41 100 Interpret results from the landmark CDK4/6i RCTs 58 62 61 53 64 56 100 Interpret RWE related to the use of CDK4/6i in patients who are underrepresented in RCTs* 62 62 63 58 74 65 100 Identify the latest updates from CDK4/6i RCTs 62 60 63 61 62 82 100 Average accuracy score for all 24 LOs 71 72 73 69 74 64 100 *Significantly different between professions (p<0.05; one-way ANOVA).