Decision-making about adjuvant chemotherapy in node neg, ER+, HER2- EBC requires balancing likely absolute benefits with treatment-related side effects. Health literacy and numeracy in general populations are often poor and many clinicians find explaining risk and uncertainty challenging especially when set against a backdrop of fear and anxiety. We developed and evaluated an educational program to aid discussions about gene expression profiling test (GEP) results from OncotypeDx and EndoPredict.
The 8 hr workshop contained: - a section on the science behind GEP tests, an interactive lecture on the psychology of risk and facilitated group discussions about different strategies demonstrated in 7 filmed scenarios showing doctors talking to patients with high and low risk scores (RSs). Pre and post workshop participants were recorded discussing RSs with trained patient simulators. Recordings were coded using a study specific scoring system by experienced researchers blinded to time-point. A priori hypotheses were that post workshop (a) participants’ communication skills discussing risk of recurrence would improve i.e. competence would be measurably better, (b) participants would feel more confident handling such consultations i.e. self-confidence/self–efficacy would be enhanced.
65 UK cancer healthcare professionals (HCPs) attended workshops. The rate re-rate reliability and inter-rater reliability for researchers coding the digital pre and post course recordings showed kappa statistics of 0.8101, SE.=0.1517 and 0.9123, SE = 0.0712 respectively. Conditional logistic regression models comparing the 2 scores observed at each time-point showed significant and positive changes in odds ratios for every key information area. HCPs’ self-rated confidence levels increased significantly post intervention for each key topic (P < 0.001). Average workshop satisfaction ratings were 9.6/10 All attendees stated they would ‘definitely’ recommend workshops to colleagues.
TARGET workshops significantly improved the communication skills and confidence of HCPs discussing risk and GEP test results in ways likely to assist patient decision-making about adjuvant chemotherapy in EBC.
University of Sussex.
Breast Cancer Research Foundation (BCRF).
All authors have declared no conflicts of interest.