2.  Materials and Methods

A mixed methodology was used to identify gaps in care, employing both qualitative and quantitative research. Multiple components were thoughtfully designed to enhance our understanding of current gaps in knowledge, practice, and attitudes that influence care. While each needs assessment component provides insight into facets of clinician behavior, the systematic and integrated evaluation of data across all components served to identify and quantify gaps in knowledge, attitudes, competencies, current clinical practice, and barriers to change.

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To ensure the collection of valid and reliable data for the assessment, a systematic process was used to design, develop, and validate the needs assessment tools. This process included the review of peer-reviewed literature, assessment and validation by clinical experts, and validation testing within the target audiences. This grounded theory approach resulted in survey items that are relevant to the research, clear and understandable to the target audiences, and written in accordance with best practices in survey design. Specific components of the needs assessment were:

  • Literature Review: A thorough review of the clinical literature was conducted in order to inform the creation and design of the interview guide and the survey questions. Project partners reviewed clinical practice guidelines, peer‐reviewed journals, and other sources of published literature. The literature review served to define standards of best practice and identify areas in assessment and treatment where guidelines and practices are unclear. A further literature analysis was conducted to supplement the learnings from the interview, survey, and expert analysis data.
  • In‐depth Interviews: Interviews were conducted with healthcare professionals who have experience managing and treating geriatric patients with cancer. Subjects for these interviews included oncologists in the academic setting, community oncologists, oncology patient/nurse navigators, and oncology nurses. Interview participants were recruited from multiple sources, including database queries of Boston University School of Medicine and Haymarket Medical Education (HME)/myCME.

Participants opted into these 60-minute telephone interviews by replying to targeted email invitations, and received an honorarium to compensate them for their time. The interviews were semi-structured, allowing the participants to discuss issues and needs surrounding treatment of geriatric patients with cancer. The questions were initially open and broad to allow maximum latitude in the responses. In later interviews, however, the questions were more refined, allowing the interviews to be more directed. The purpose was to identify gaps in knowledge, competence, and performance as well as identify key issues and influences on clinical behavior. These interviews also helped to identify decision points in the management of geriatric patients with cancer where educational interventions may be helpful. The interviews served to inform development of the survey tools used in the quantitative assessment. The interview data also assisted in interpreting the survey findings, providing examples and explanations.

  • Quantitative Clinician Survey: This 55-item quantitative assessment was distributed via email invitation to healthcare professionals who manage and treat geriatric patients with cancer. Using estimated response rates based on similar past surveys, partners contacted a sufficient number of healthcare professionals to ensure approximately 100 completed surveys for the primary target audience of medical oncologists. Repeated sampling of the target audience ensured that needs assessment findings reflected the diversity of healthcare professionals who treat geriatric patients with cancer. The survey tool, consisting of multiple‐ choice questions, took participants approximately 13 minutes to complete. In addition to basic demographic data, the survey consisted of 2 main sections:
    1. Clinician Change Readiness Inventory®: Designed to assess perceived needs, this tool quantified forces, attitudes, and images around treatment of geriatric patients with cancer. This assessment also identified barriers to using new therapies in geriatric patients.
    2. Clinical Knowledge and Practice Assessment: Created to assess and quantify actual clinician knowledge and practice gaps related to assessment and management of geriatric patients with cancer.

The Practice Assessment multiple choice questions featuring clinical vignettes were intended for the medical oncologist audience, since these individuals primarily make the decisions related to treatment.

After development in consultation with the clinical advisory panel, beta-testing of the survey was performed in 2 phases. First, the instrument was sent to members of the target audience during interviews to discuss each item, the response chosen by the clinician, and feedback on the question‐and‐response set. After refinement based on the information learned through the interviews, the survey was placed online and released to a sample of the target audience to check for adequate item variance, reliability, and convergent/discriminant validity with respect to other measures.

Survey participants were recruited via multiple channels. These channels included:

  • Identification of participants from the Boston University School of Medicine and HME/myCME databases.
  • Clinicians in the ResearchNow database. ResearchNow is a company that provides researchers access to panels of clinicians who are members of the target audiences and fit the research criteria.

On completion of data collection, an advisory panel of clinical experts (physicians, a nurse, and a patient navigator) convened to assist professional educators with interpretation of these data. This panel reviewed the data and suggested further sub-analyses and developed implications for future education. Faculty involved in the needs assessment design and analysis, tool validation, and data interpretation were selected by Boston University School of Medicine and HME, based on the faculty’s commitment to education and expertise in the treatment of geriatric patients with cancer.

Any conflict of interest was resolved in accordance with the policies of Boston University School of Medicine.