Notably, all the gaps are significantly above the threshold of 0.5 (Figure A10). The gaps near 1.0, including “Adjust treatment,” “Determine optimal treatment,” “Manage side effects,” and “Collaborate with team” demonstrate very significant gaps. This signals that clinicians recognize a drastic need for improvement. It is important to note that gap scores over 1.5 tend to signal that that gap is perceived as insurmountable. As such, the gap scores here reflect that clinicians recognize the gap, express readiness to change, and feel that the gap is capable of being closed.

Figure A10. Competency gaps.

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Attitude toward change

Survey participants were asked to rate their attitude toward change (Figure A11). The score of 3.78 for “The way I practice in this clinical area is acceptable to me” is notably low. Typically, scores on this statement are well over

4.0 in other clinical areas, which demonstrates clinicians recognize areas for improvement in the way they administer care to geriatric patients with cancer. The level of agreement with the statements “I may need to examine one or more of my clinical practices in this area” and “I plan to change the way I practice in this area in the near future” clearly demonstrated that the physicians taking this survey are open to changing the way they practice based on education on the current data and treatment trends.

Figure A11. Attitude toward change.

Forces for Change

Physicians are encouraged to change their clinical behavior based on the presence or absence of various forces in their environment. The forces for change are broken into 3 types: professional forces, social forces, and personal forces. These forces were measured by asking physicians to rate their level of agreement from 1 (low agreement) to 5 (high agreement) with statements related to each force (Figure A12).

Figure A12. Forces for change.

The highest forces for change were the professional forces “I wish I were more knowledgeable in this area” and “New information in the literature has increased my interest in adopting new practices in this area”. Professional forces are the most often cited reason for change in clinical practice and demonstrate a desire for competence. The social forces encompass environmental elements that impact a clinician from outside and over which they feel that they have little control. The social forces, “The expectations of the systems (hospital, ACO, etc.) in which I work are a force for change in treating geriatric patients” and “Recent regulations or policies require that I do things differently in this area of my clinical practice,” were ranked below the professional forces. The final social force, pressure from colleagues, was ranked lowest, just behind the lone personal force of financial advantage to changing practice. The most effective drivers of change in this area are professional forces. Oncologists will be most receptive to educational activities that indicate new information applicable to their patient population.