5. Conclusion

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The data collected during the process of creating this needs assessment present a broad perspective on some of the challenges and issues in the management of geriatric patients with cancer in the academic and community-based settings. Through careful analysis of clinical guidelines and literature, physician interviews, survey data, and expert opinion, the project partners synthesized a series of key educational implications and corresponding recommendations for continuing professional development.

Five key practice performance gaps and associated needs have been identified from this research. These gaps describe issues that can impact clinical efficiencies and, ultimately, quality patient care and outcomes. Each of the key practice performance gaps is addressable from an educational perspective.

As stated earlier, the majority of these gaps overlap and reflect two primary themes: the importance of staying current on best treatment practices and effective communication. Individuals involved in the management and treatment of geriatric patients with cancer are challenged in 1) selecting the optimal treatment choice with consideration of comorbidities, 2) a lack of time or knowledge in using appropriate tools to assess the patient’s functional, cognitive, and social support status, 3) overcoming multiple barriers to compliance that are specific to the geriatric community, 4) engaging in effective and meaningful discussions with primary care physicians to maintain a continuum of care, and 5) recognizing how the goals and needs of geriatric patients may differ from those of younger patients. Healthcare providers treating and managing geriatric patients with cancer exhibit a desire to learn and a significant readiness to change if shown evidence of benefits.

Improving patient-physician and oncologist-primary care physician communication skills is a common theme that has emerged as the foundation of the educational strategy recommended for future CME interventions. Embedding the topics of communication and patient engagement into presentations of patient cases is recommended to emphasize the importance of taking a holistic approach to patient care. Oncologists recognize a need for more effective communication skills surrounding care of patients and demonstrate a willingness to change their clinical practice. In this instance, integration of the patient voice may be most successful in communicating this concept. Suggested approaches to education include integration of patient perspectives into clinical cases and an emphasis on a multidisciplinary team approach to disease management, including the incorporation of nurse navigators and/or case managers. Consideration of an emphasis on patient engagement and integration of patient perspectives is recommended for all future CME interventions. Creation of tools or resources that engage patients in decision making can facilitate more detailed and productive conversations. Benefits of focusing on the concept of patient education include the potential to alleviate the burdens on the physician, minimize patient misinformation, and improve patient satisfaction and outcomes.

The survey results on Forces for Change indicate that new information in the field is a strong driver for change in clinical practices, and results on Barriers To Adopting New Therapies indicate that lack of data around the use of new therapies in the geriatric patient may be inhibiting this change. The Attitudes Toward Change data indicate that oncology clinicians are willing to change if provided the appropriate information. In order to address gaps related to selecting the optimal treatment approach and personalizing therapy regimens based on individual patient characteristics, future CME should include a modeling forum or clinical vignettes. Patient cases are complex and, therefore, there is an ongoing need for physicians to be exposed to multifaceted clinical vignettes. Additionally, integration of patient case scenarios makes concepts more recognizable and relevant. This approach may be executed through a small group educational format using teaching cases, similar to Tumor Boards; however, patient case scenarios also lend themselves well to symposium and text-based cases featuring video vignettes. When educating clinicians about therapies, content should cover efficacy, side effects, assessment of risk/benefit in geriatric patients, and impact on commonly observed comorbidities. Where appropriate, the financial implications of therapies and the possible social supports required for them should be covered as well, in order to give clinicians an idea of potential patient access challenges. Interviewees and our expert panel suggest that patient-based clinical vignettes are well received when presented by colleagues with more experience.

Overall, pertinent, high‐quality, evidence‐based education that meets identified educational needs will ensure that healthcare professionals continually improve their practice, ultimately resulting in better care and optimal clinical outcomes in geriatric patients with cancer.

Priya Wanchoo, MD, CHCP1*, Chris Larrison2, Tom McKeithen2, Kevan L. Hartshorn, MD3, Eric Hardt, MD3, Diane L. Sarnacki3, RN, MSN, AOCN, Katie Finn3, and Julie White3

Author Contributions: Conceptualization, P.W.; Validation, K.L.H. and E.H.; Formal Analysis, C.L. and T.M.; Investigation, C.L. and T.M.; Data Curation, C.L. and T.M.; Writing-Original Draft Preparation, P.W.; Writing- Review & Editing, K.H., E.H., D.L.S., and K.F.; Visualization, P.W.; Supervision, J.W.; Funding Acquisition, P.W

Funding: This research was supported by an educational grant from Pfizer IGLC.

Conflicts of Interest: The authors declare no conflict of interest.

Acknowledgements: The Boston University School of Medicine, Haymarket Medical Education and Healthcare Performance Consulting would like to thank Kevan L. Hartshorn, MD, Professor of Medicine, Fellowship Program Director, Section of Hematology & Oncology, Boston University School of Medicine, Eric Hardt, MD, Boston Medical Center, Geriatrics Section, Diane L. Sarnacki, RN, MSN, AOCN, Boston Medical Center Oncology Clinical Nurse Educator and Katie Finn, Manager, Cancer Center Patient Navigator Program, Boston Medical Center for their contributions to this needs assessment.