Virtual Tumor Board Improves Nurses’ Knowledge of Myelodysplastic Syndromes

An educational activity designed by i3 Health has demonstrated significant learning gains in the treatment and management of myelodysplastic syndromes (MDS) and has been presented at the 2021 Greater Los Angeles Oncology Nursing Society (GLAONS) Oncology Care Summit.

A group of myeloid clonal hematopoietic disorders with a relatively heterogeneous spectrum of presentation, MDS, is associated with clinical problems resulting from cytopenias, which can evolve into acute myeloid leukemia. The incidence of MDS increases with age; the median age at diagnosis is 70-75 years. The generally advanced age of the patients, their comorbidities, their difficulty in tolerating treatment, and the overall heterogeneity of the disease make diagnosis and management challenging for clinicians. An educational need was highlighted by the baseline data collected from i3 Health’s continuing medical education (CME)/nursing continuing professional development (NCPD)–approved online Virtual Tumor Board: Diagnosis and Management of Myelodysplastic Syndromes led by David Steensma, MD, FACP, Associate Professor of Medicine at Harvard Medical School; Reza Nejati, MD, Assistant Professor of Pathology at Fox Chase Cancer Center; and Ilene Galinsky, BSN, MSN, ANP-C, Senior Program Research Nurse Practitioner at Dana-Farber Cancer Institute.

A total of 553 learners engaged in the activity, and 456 completed the activity for credit. The activity was available online from May 21, 2020, until May 20, 2021. The majority of learners were registered nurses (83%) and physicians (8%), followed by individuals who selected “other” for their profession (4%), nurse practitioners (3%), physician associates (1%), and pharmacists (1%). Participants had been in practice for an average of 13.7 years and saw an average of 9.8 patients with MDS 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 data demonstrated a significant shortfall in knowledge in topics related to personalized care for patients with MDS, including the following: assessment of patient and tumor characteristics; differentiation of emerging data and guideline recommendations on therapeutic approaches for lower-risk, higher-risk, and therapy-related MDS; and the evaluation of supportive care strategies that can help patients with MDS to achieve their goals of cancer therapy. Prior to beginning the activity, only 36% of learners identified that luspatercept treatment could help a patient with lower-risk MDS with ring sideroblasts achieve transfusion independence; only 45% of learners correctly identified that patients with higher-risk MDS and a TP53 mutation are significantly more likely than patients with other mutations (including RUNX1, TET2, and IDH2) to respond to decitabine; slightly more learners (49%) correctly chose azacitidine or decitabine as the appropriate course of treatment for a patient with high-risk MDS; half of learners (50%) were able to identify diarrhea as the most likely adverse event of deferasirox iron chelation therapy for an iron-overloaded patient with lower-risk MDS; and most learners (74%) were able to identify that a TP53 mutation would decrease the chance of overall survival for a patient with high-risk therapy-related MDS.

Significant learning took place during the activity, as revealed by the learners’ performance on the posttest. Greater than 90% of learners identified the correct answer for each question, with statistically significant (P<0.001) learning gains on all topics: 55% learning gain in identification of the efficacy of luspatercept for treatment of low-risk MDS; 49% learning gain in the response to decitabine for a patient with a TP53 mutation; 42% learning gain in the identification of the efficacy of azacitidine vs decitabine for MDS treatment; 41% learning gain in the identification of adverse events associated with deferasirox treatment; and a 23% learning gain in the identification of the prognosis of patients with a TP53 mutation and MDS.

Upon completion of the activity, 84% of participants felt more confident in treating their patients with MDS, and 84% felt that the material presented would be used to improve the outcomes of their patients.

The results indicate that online, case-based, CME/NCPD-approved activities can result in statistically significant improvements in participants’ clinical competence related to the diagnosis and management of MDS. i3 Health has determined that the multidisciplinary team may benefit from future CME/NCPD-approved activities and will work to develop innovative online education to provide further and updated MDS education. 

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