Results of an educational tool for residents and referring physicians on palliative radiation for bone metastases.

Authors

null

Nina Desai

Medical College of Wisconsin, Milwaukee, WI, US

Nina Desai , Malcolm David Mattes , Eric Bonar , Grant Robertson , Candice Aitken Johnstone

Organizations

Medical College of Wisconsin, Milwaukee, WI, US, West Virginia University, Morgantown, WV, Medical College of Wisconsin, Milwaukee, WI

Research Funding

Other

Background: Palliative radiation therapy (RT) for painful bone metastases is underutilized in the United States (US), perhaps due to inappropriate use of multi-fraction (MF) regimens over more convenient, less costly, and equally effective single fraction (SF) regimens. Practice patterns may change with improved knowledge of radiation oncology residents (ROR) and non-radiation oncology physicians who refer patients for palliative RT. The aim of this study was to provide evidence-based educational content to these groups, and assess knowledge and views before and after. Methods: In April-June 2017, an electronic educational tool was sent to medical oncology and palliative care physicians, and ROR in the US. Multiple choice questions assessed knowledge, and were followed by evidence supporting the correct answer. Likert and sliding scales gaged tool impact. Chi-square and Mann-Whitney tests compared groups and pre/post-test responses. Results: Responses were obtained from 109 (2%) referring physicians (RP) and 135 (21%) ROR. ROR had higher scores than RP for 8 of 9 objective questions. RP were less likely to know that SF and MF are equivalent in terms of pain response (64 v. 91%, p < .01) and subsequent analgesic use (86 v. 95%, p = .02), or that SF is associated with a higher retreatment rate (27 v. 93%, p < .01). ROR were less likely to know that SF and MF are equivalent for patients with a high likelihood of long term survival (25 v. 56%, p < .01). After viewing the content, ROR felt more knowledgeable [mdn 3 (IQR 3-4) v. 4 (IQR 3-4), p < .01], and RP felt more empowered [mdn 3 (IQR 2-4) v. 4 (IQR 3-4), p < .01]. RP found the survey more helpful, and knew less of the data prior [mdn 50 (IQR 25-75%) v. 80% (IQR 66.3-90%), p < .01]. Despite knowing the data, ROR preferred SF less than RP at completion (67 v. 85%, p < .01). Conclusions: This study demonstrates a need for educational content for multidisciplinary providers on appropriate palliation of bone metastases. Despite ample knowledge, the bias of practicing radiation oncologists for MF is being passed onto residents. Greater knowledge may translate into more effective referral patterns and patient advocacy by RP, and potentially improve utilization of palliative RT in the US.

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Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Publication Only

Session Title

Publication Only: Patient and Survivor Care

Track

Patient and Survivor Care

Sub Track

Palliative Care and Symptom Management

Citation

J Clin Oncol 36, 2018 (suppl; abstr e22167)

DOI

10.1200/JCO.2018.36.15_suppl.e22167

Abstract #

e22167

Abstract Disclosures

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