Sometimes it can feel as if cancer treatment goes through a paradigm shift every few months – and that feeling is perhaps most acute in lung cancer, which has seen advances in recent years that have transformed this once almost-untreatable disease into one where patients can have real hope.
Treatment for lung cancer already varies widely depending upon the type of cancer (small cell or non-small cell) and its stage. The new, innovative therapies emerging every year – from precision, biomarker-specific medicines to immunotherapy and gene therapy – only add to this complexity.
With so many developments coming so rapidly, it is more important than ever – but also more difficult – for oncologists to stay current with the latest information on how to achieve the best outcomes for patients.
“Lung cancer treatment involves a multitude of decisions that must be made by the clinician and patient, including testing for biomarkers, determining best treatment (from surgery, radiation, chemotherapy, and targeted therapy), and managing potential adverse reactions to treatments,” says Katie Lucero, PhD, director of outcomes research at Medscape.
“Diagnosing different targetable mutations requires specific knowledge about how and when to test for these. Or, if a broad way of testing becomes standard practice (e.g. NGS) distilling the targetable mutations from the non-targetable ones might become more difficult. Which therapy do you begin with? The one targeting X or Y?”
According to Medscape, over half of healthcare professionals report that their most recent practice change was related to treatment, and they therefore see medical education as one of the most valuable sources of information for improving their knowledge of medicines – as well as diagnostic assessments, screening and prevention, and communication to patients and the larger care team.
But in an environment as varied as lung cancer, there’s a risk that traditional medical education approaches could fall short, and more adaptable methods are needed.
“Learning about these changes requires a lot of case-based educational activities that would help physicians practice the newly acquired knowledge in a virtual space, receiving guidance from experts to build and reinforce their knowledge and practices so that they can provide optimal management decisions in their clinical practice,” says Lucero.
She uses an example from Medscape’s MedSims virtual patient simulation platform:
“This platform simulates patient visits and the use of an electronic health record system to order tests, view test results, and make treatment and other patient management decisions. This allows the clinician to make decisions in a consequence-free environment and get real time feedback on those decisions.”
Lucero thinks the solution could lie in embracing online continuing medical education (CME) techniques like MedSims.
Online CME personalises learning by identifying gaps in knowledge and skill through pre-activity assessment of participants, and then delivering independent, accurate, unbiased, scientifically rigorous educational content via formats that are clinically relevant and interactive in nature.
These can be anything from live events to written publications, online programmes, audio and video content or immersive simulations.
“During congresses there is a great deal of new clinical data coming out regarding different therapies in different stages of development,” Lucero says. “It is important that physicians receive evidence-based, unbiased information from thought leaders who can distill and educate physicians on this new data and its implications for clinical practice.
Professor Sanjay Popat, consultant thoracic medical oncologist at The Royal Marsden Hospital, has backed this up, saying that in an age of “increasing complexity” for the treatment of lung cancer, timely summaries from key experts are “excellent” for helping to place new data into current context.
CME aims to be evidence-based, current, objective, and free from commercial bias. In addition, it is designed in such a way that it will meet learning objectives that were developed from a needs assessment that defined the healthcare gap, the practice gap, the desired outcomes, and the needs of the target audience.
“CME means that the education was developed using evidence-based instructional design principles that maximise the chances the target audience will actually learn from the education,” Lucero says. “CME is effective because it meets certain standards that must be upheld in order to be certified by an accredited CME provider, like Medscape.”
An analysis of cancer immunotherapy activities from Medscape has shown that timely continuous education designed to meet the learners’ needs is impactful, resulting in an average 33% relative improvement from pre- to post-education from 2014 and 2018. However, on average, about a third of participants still needed more education on the topics covered.
Lucero adds that another reason CME is effective is that clinicians trust it. A recent Medscape global survey showed that for 33% of physicians, the source of information for physicians’ most recent change to practice was CME.
“The landscape in thoracic oncology is rapidly changing,” says Enriqueta Felip, head of the Thoracic Cancer Unit at Vall d’Hebron University Hospital in Barcelona. “We can characterise tumours much better and offer much more individualised treatment strategies. For all these advances to flow, independent CME is fundamental in helping professionals to maintain, develop or increase their knowledge.”
“If an audience isn’t going to use it, then how can it be effective?” Lucero adds.
“There is no disadvantage to offering certified medical education except that not everyone needs the credit it offers, so sometimes there may not be an incentive to the healthcare provider to take it if they feel they are getting the information they need from published studies, colleagues, and clinical news.
“The disadvantage of CME from a pharma company perspective is that they cannot have control over the content in any way. Credibility of content is possible due to the fact that pharma/biotech companies do not have control.”
Lucero notes that the scientific rigour underpinning CME is a key advantage – particularly when it comes to using these scientific processes to personalise content to best suit each user’s needs.
“The closer the content is to the specific need of the learner, the more likely it is to make an impact,” she explains. “We utilise tailored learning to assess where one is prior to any education and then serve content based on responses to that assessment.
“We then provide custom feedback that is dependent upon one’s decision in an open-ended patient simulation. We also serve personalised content to our members using artificial intelligence (AI), making it more likely that our members have the content they need when they need it.
“Our registration-based membership allows us to track, longitudinally, individual members and their learning path. We can examine within the same learner what happens from one activity to the next. This allows us to do more robust analyses that minimise errors and increase statistical precision.”
This rigour and personalisation comes in before the company even begins designing the programme, when Medscape uses a scientific process to identify the outcomes users hope to achieve based on what is relevant to the current challenges in lung cancer.
“We keep the end in mind when developing the content and assessment techniques, designing the format, and delivering to the target audience. This maximises the chances of us assessing outcomes that matter for patient care in lung cancer.”
The company has a variety of methods for measuring these outcomes, including repeated-pairs pre/post assessment using multiple choice questions, assessing intended and actual changes in practice after education, and assessing decisions made through case vignettes, and patient simulation. They also assess confidence using Likert-type scales.
The challenge is, of course, that as the lung cancer treatment landscape continues to change rapidly CME tools need to be ready to adapt at any time. Lucero says that this, too, is made possible by continuous improvement processes.
“Adaptation can be based on plan-do-study-act (PDSA) cycles where we utilise what we learned from the previous programmes in a therapeutic area to make adjustments to the next set of programmes,” Lucero says.
“For example, we may learn from one programme that utilised video and also had downloadable slides that the slides were accessed by 60% of the learners, so in the next programme, we will make sure slides are available.
“We may also learn from that programme that 40% of oncologists still need education on a certain topic as evidenced by 40% not answering a set of questions correctly. This will help focus the content of the next programme.”
Lucero hopes that, ultimately, CME programmes like this underpinned by scientific rigour will improve knowledge, competence, and performance among HCPs.
“We are using AI-aided technology to deliver the right education at the right time so that we can ultimately improve the impact of that education on patients,” she says.
“Mostly, I hope that these knowledge and performance changes will translate to better patient care and patient health.”
Katie Lucero, PhD, is director of outcomes and insights at Medscape Education Global. She has nearly 20 years of experience in research and evaluation in developmental psychology, public health, health outcomes, and education (K-12 and CME). At Medscape, Dr Lucero oversees and leads strategy in all endeavours where data is used to tell a story. Prior to that, she was director of research and evaluation for McREL International where she was responsible for designing, pursuing, and managing education evaluation and research studies, including government projects. Finally, she directed numerous quality improvement and health outcomes studies during her tenure at a contract research organisation and evaluated public health programmes at the Centers for Disease Control and Prevention (CDC) in the US.
For over 25 years, Medscape Education has been a trusted and essential resource for healthcare professionals throughout their careers, growing into the global healthcare provider it is today, reaching 4.4 million physicians worldwide with the news, resources and education they need in over 30 therapeutic areas. Medscape Oncology enjoys a unique and unparalleled relationship with its vast, active member community of oncologists around the world. With a shared commitment to improving cancer care, Medscape provides ubiquitous access to learning resources across multiple channels, offering a variety of personalised, evidence-based, and clinically relevant educational solutions to support the entire oncology care team and improve patient outcomes.
To learn more, please contact Stephen Dunn, executive director, Medscape Education, Oncology at firstname.lastname@example.org / +44 (0)203 802 1146