Learning Needs in Immune Thrombocytopenia

Immune thrombocytopenia (ITP) is a heterogeneous disorder that involves a shortage of platelets, or thrombocytes, and can result in excessive bruising or bleeding. Diagnosis and treatment are challenging due to the lack of specific diagnostic criteria and the widely varying clinical features: some patients remain asymptomatic, whereas others experience troublesome bruising or even life-threatening intracranial hemorrhage. The optimal management of ITP necessitates an individualized approach that accounts for the complex combination of considerations.

Knowledge gaps regarding the treatment of ITP were confirmed in the baseline data collected from i3 Health’s continuing medical education (CME)/nursing continuing professional development (NCPD)–approved visiting faculty meeting series titled Optimizing the Clinical Outcomes of Patients with ITP, led by James B. Bussel, MD, Professor Emeritus of Pediatrics at Weill Cornell Medicine in New York, and Allison Miller Imahiyerobo, APN, an advanced practice nurse at Hematology and Oncology Physicians of Englewood, New Jersey.

Of the 901 learners who took the pretest and began the activity, which was available online from November 6, 2019, to November 5, 2020, 848 saw it through to completion. The majority of learners (90%) were registered nurses, followed by nurse practitioners (4%), advanced practice nurses (2%), physicians (2%), individuals who selected “other” for their profession (2%), and 2 physician assistants and 2 pharmacists. Participants had a wide range of practice experience, ranging from less than five years to over 20 years, and they saw an average of nine patients with ITP per month. Learners were given a pretest prior to beginning the activity and a posttest consisting of the same questions following the activity’s conclusion.

The baseline assessment demonstrated significant knowledge gaps regarding the management of ITP, efficacy of emerging therapies, and risk assessment. Only 20% of learners could correctly answer a question about platelet count management; only 23% of learners correctly identified avatrombopag and eltrombopag as oral thrombopoietin receptor agonists (TPO-RAs); only 21% could correctly counsel a patient about the safety of fostamatinib treatment; and only 35% correctly chose to continue the TPO-RA and anticoagulate a patient whose platelet count has improved after treatment with a TPO-RA but who has developed deep vein thrombosis (DVT). More learners (69%) correctly identified dexamethasone as a better treatment option than prednisone for a patient presenting with oral mucosal blisters, severe, hard-to-stop epistaxis, and a platelet count of 10,000 who has a history of diabetes and hypertension.

Learners’ performance on the posttest revealed that significant learning took place during the activity with respect to all topics. Learners showed a nearly 70% improvement in knowledge that corticosteroids, intravenous immunoglobulin, and anti-D immunoglobulin are all aimed at preventing platelet destruction (89% vs 20%); a 66% improvement in correct identification of the oral TPO-RAs (89% vs 23%); a 74% improvement in association of fostamatinib treatment with thrombotic events (95% vs 21%); a 60% improvement in the correct choice of therapeutic approach for a patient treated with TPO-RAs that develops DVT (95% vs 35%); and a 30% improvement in the correct treatment choice of dexamethasone for a patient with a history of diabetes and hypertension who presents with a low platelet count (99% vs 69%).

Learners’ performance on the pre- and post-activity assessment suggested that their competence improved regarding ITP risk assessment, staging, and efficacy and safety of emerging therapies. i3 Health has determined that the multidisciplinary team may benefit from future CME/NCPD–approved activities that provide further and updated ITP education.

Upon completion of the activity, 85% of participants felt more confident in treating their patients with ITP, and 85% felt that the material presented would be used to improve the outcomes of their patients. 

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