Communication Practice Patterns of US Healthcare Professionals with CML Patients Undergoing Oral Tyrosine Kinase Inhibitor Treatment
Authors: Fagerlie Sara R , Heintz Alison , Haas Maureen 
Published: November 2019

Abstract
Patient adherence to oral tyrosine kinase inhibitor (TKI) treatment remains a significant challenge for the hematology healthcare professional treating patients with chronic myeloid leukemia (CML). Current data suggests that only a minority of CML patients are perfectly adherent to TKI treatment. Moreover, patients with less than 90% adherence have significantly lower molecular response rates and, ultimately, outcomes. Therefore, guidelines currently recommend evaluating adherence whenever a therapeutic milestone is not achieved. Given the importance of adherence to optimal CML treatment, communication patterns of US healthcare professionals and the impact of education on those practice patterns were evaluated.
From December 2012 to April 2014, 38 live 1-hour educational interventions were implemented in accordance with the essential areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) and Accreditation Council for Pharmacy Education (ACPE). The programs educated 631 healthcare professionals practicing in the community setting. Participants were asked a series of questions on communication and follow-up with CML patients prior to and following an educational intervention. Practice pattern, knowledge, and competence were assessed via case vignettes prior to and immediately following each educational activity via an audience response system. Surveys completed 6 weeks following each activity assessed practitioner performance and long-term incorporation of the educational content.
Prior to the education less than 50% of practitioners evaluated adherence for a CML patient missing major response milestones. The majority of practitioners instead opted to switch to a different TKI or increase TKI dose. Education profoundly increased the proportion of practitioners choosing to evaluate adherence in both the short- and long-term. Furthermore, prior to the education, only 60% of healthcare professionals reported always discussing the impact of non-adherence to oral TKI treatment on clinical outcomes. Immediately following the education 86% reported intent to always discuss the impact with patients. However, preliminarily, this intent did not appear to be incorporated into clinical practice for those physicians responding to the long-term follow-up survey. Most practitioners (85% prior to the education and 94% following the education) reported using a tool to facilitate dose management for patients on an oral TKI. A pillbox was the most commonly used tool (41% prior to the education, 38% following the education). Education resulted in an increase (+13%) in those practitioners incorporating technology (text, email, or cell phone application) as a dose management or patient adherence tool. In the long-term, 64% of survey respondents agreed or strongly agreed that participation in the educational activity increased their likelihood to use a tool to aid dose management and adherence (no participants disagreed).
Overall, these data suggest that among community practitioners, discussion of adherence to oral TKI treatment for CML is limited. Education positively improves the percentage of practitioners who recognize when adherence should be evaluated, the importance of patient-practitioner discussion on non-adherence, and incorporate tools to facilitate patient dose management and adherence to oral TKI treatment.

Disclosures
Fagerlie: Novartis: Unrestricted Educational Grant Other. Heintz:Novartis: unrestricted educational grant Other. Haas:Novartis: unrestricted educational grant Other.