Addressing Challenges in Chronic Lymphocytic Leukemia with Continuing Education: Impact on Practice Behaviors and Knowledge
Authors: Roc Anne C , Vose Julie M. , O'Brien Susan M. , Turell Wendy 
Published: October 2019

Abstract
Background: As the era of personalized medicine draws ever closer for patients with CLL, advances in understanding of prognostic factors, biomarkers, drug classes and new agents pose a continuing challenge for clinicians to remain informed and competent in managing CLL. Clinicians must be able to determine the best treatment regimens for their patients based on cytogenetic profiles and in accordance with current treatment guidelines, evaluate recent efficacy and safety data and how they apply in practice for individual patients, anticipate and manage adverse effects, and address barriers to adherence. To address these challenges, we created continuing medical education (CME) activities focused on: 1) determination of optimal treatment strategy through use of prognostic and patient criteria, including mutations and abnormalities; 2) stratification of regimens, 3) assessment of emerging agents, sequential and combination regimens, and use of clinical trial data pertaining to patients with relapsed/refractory CLL; 4) planning individualized treatment algorithms; and, 5) addressing treatment barriers. Learner responses were evaluated to assess the influence of education.
Methods: Two sets of consecutive online video-based programs were developed in January 2016 and January 2018 to address the identified knowledge and practice needs. Each respective program consisted of two 1-hour CME activities (4 hours overall) with slides, polling and live questions; programs were initially live and immediately made available on-demand at www.OMedLive.com for 6 months. CME test questions were administered at 3 time points (pre-activity, immediate post-activity, and 8-weeks post). Data from these questions, live polling responses, and learner-submitted questions 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/follow-up post, respectively). Effect size was computed using Cohen's d.
Results: In total, 869 learners took part in the 2016 and 2018 programs (561 and 308). Overall, 103 out of 437 learners (25% at the point of evaluation) completed all pre, post, and follow-up surveys. 71% reported the educational activity positively influenced patient experience or outcome, and 76% reported it played a role in positively altering their clinical practice. As the result of education, learners reported commitments to change regarding: medical/practice knowledge (88%), care attitudes (84%), practice behavior (84%) and patient clinical outcomes (79%). Learners showed improvements on 8 knowledge questions and 4 competence questions, including statistically significant lifts in 3 case questions and 2 knowledge questions. Specifically, they demonstrated significantly improved competence via 3 case scenarios which required identifying the optimal next step for various patients with del17p, with and without IgHV unmutated CLL. They also showed significantly improved knowledge on patient-specific criteria for selecting treatment strategies for patients with CLL, and clinical staging of CLL. Although this study is limited by lack of access to practice data, outcomes results and participant questions indicate clinicians benefit from online continuing education on CLL.
Conclusions: Ongoing education on CLL can yield immediate and sustained gains in knowledge, competence, and performance, and improve the ability to provide individualized treatment for patients.

Disclosures
Vose: Kite Pharma: Research Funding; Legend Pharmaceuticals: Honoraria; Merck Sharp & Dohme Corp.: Research Funding; Novartis: Honoraria, Research Funding; Bristol Myers Squibb: Research Funding; Celgene: Research Funding; Abbvie: Honoraria; Seattle Genetics, Inc.: Research Funding; Incyte Corp.: Research Funding; Acerta Pharma: Research Funding; Epizyme: Honoraria; Roche: Honoraria. O'Brien:Acerta: Research Funding; Gilead: Consultancy, Research Funding; Kite Pharma: Research Funding; Abbvie: Consultancy; Aptose Biosciences Inc.: Consultancy; TG Therapeutics: Consultancy, Research Funding; Regeneron: Research Funding; Sunesis: Consultancy, Research Funding; Astellas: Consultancy; Vaniam Group LLC: Consultancy; GlaxoSmithKline: Consultancy; Janssen: Consultancy; Pharmacyclics: Consultancy, Research Funding; Alexion: Consultancy; Pfizer: Consultancy, Research Funding; Celgene: Consultancy; Amgen: Consultancy.