Figure A7. Utility of educational platforms.

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Finally, clinical practices were assessed (Figure A8). While physicians largely agreed with the statement “I regularly use formal tools to assess performance status,” when questioned more deeply if they use formal tools to assess cognitive status and identify risk for chemotherapy intolerance, scores fell below the midway point of 3.0. Regarding patient education, agreement was just over the 3.0 midpoint. The impression from both the interviews and the advisory panel was that most physicians use myriad educational resources for patients, and the quality of these resources varies widely. Finally, referral of geriatric patients for a consult to a geriatric specialist or to palliative care was almost exactly at the agreement midpoint, indicating that while clinicians may be aware of these resources, they may not be utilizing them fully.

Figure A8. Clinical practices.

Key Findings and Data Analysis

Clinical Competencies 

Clinical guidelines, literature, interview data, and expert opinion were used to create a list of evidence-based competencies for the treatment of geriatric cancer patients. The competencies are a series of statements that represent the abilities necessary for physicians to successfully manage and treat these patients.

Please rate your present and desired ability to: 

  1. Assess patient health status (comorbidities, physical function, cognition, social status, etc.)
  2. Adjust treatment options for geriatric patients based on health status
  3. Address language, religious, and other cultural issues that may affect management of the geriatric patient with cancer
  4. Communicate with the geriatric patient, family, and caregivers about desired goals of care
  5. Determine the optimal treatment regimen(s), including timing and dosing, for the geriatric patient
  6. Communicate with the patient/family/caregivers about treatment options and patient concerns
  7. Manage side effects
  8. Revise the treatment plan when necessary
  9. Collaborate with the multidisciplinary team (including primary care) about the care of the geriatric patient

In the survey, respondents were asked to rate their present and desired levels of ability for each competency. The “present ability” identifies where the respondents believe they are presently performing. The “desired ability” represents the importance the respondents place on that particular ability. Another way to view the label “desired” is how important is this competency to the demographic; how much do they value this competency as they strive to improve their clinical practice. Average responses for all respondents are presented below, with 1 representing a low level of ability and 5 representing a high level of ability.

Notably, a significant gap was seen between present and desired levels of ability in all of the competencies (Figure A9).

Figure A9. Present and desired abilities.

Competency Gaps

The average difference, or gap, between the present perceived and desired levels of competency indicates the perceived need of the learners. This gap between the perception of “what is” and “what ought to be” predicts physician motivation to learn and change. A gap of 0.5 or higher is considered to be meaningful, while a gap of 1.0 to 2.0 is ideal for clinician education; this cutoff threshold is based on previous research on forces for change and learning in the lives of physicians.