Patients and their caregivers who partner with their clinical teams to understand chronic lymphocytic leukemia (CLL) and adopt personalized treatment plans are more satisfied and achieve better outcomes with their care. How can clinical teams engage their patients to achieve this?

Shared decision-making (SDM) is one approach that can help. At the core, SDM occurs when patients and providers have an open discussion regarding the patient’s care and together make treatment decisions that reflect the patient’s treatment goals and preferences, as well as the provider’s professional experience and expert guidance regarding available clinical evidence.

As the landscape of CLL treatment evolves, it is critical for providers to stay up-to-date on emerging best practices and to convey this new information to patients. By guiding you through the key steps of SDM, this practical toolkit is designed to help you help your patients with CLL to stay educated, empowered, and engaged in their care through group educational sessions or one-on-one patient education counseling.

Regardless of when or how you choose to host these collaborative learning sessions, this guide supports you in creating a comfortable, nonjudgmental setting in which patients and their caregivers are able to ask questions, share concerns, and learn from each other’s experiences. Patients should be encouraged to participate throughout in order to facilitate important discussion, and enable the speaker to tailor the information to the patients’ baseline knowledge about CLL.

Ultimately, the key goal of this toolkit is to encourage patients with CLL to be active participants in their health care decisions and care plan through SDM, helping build a strong partnership with their CLL care teams for higher treatment satisfaction and better treatment outcomes.

For additional CME/CE activities in CLL and other disease states, visit www.primeinc.org.

www.primeinc.orgThis activity is provided by PRIME® Education. There is no fee to participate. This activity is supported by educational grants from Adaptive Biotechnologies, Genentech, and Pharmacyclics, an AbbVie Company.

References and Resources

Discussion questions to keep the educational sessions interactive and hear your patients’ experiences of living with CLL, questions or concerns regarding their treatment, and preferences for their care

Speaker notes to help you or other members in your clinical team deliver the information using language that’s easy for patients and caregivers to understand

Easy-to-read content centered on key CLL topics, including the stages of CLL, when to start therapy, current treatment options, and SDM with the CLL care team

Engaging Patients in Chronic Lymphocytic Leukemia Care:A Collaborative Toolkit for Clinical Teams

Overview

1. American Cancer Society: CLL www.cancer.org/cancer/chronic-lymphocytic-leukemia.html

2. Cancer.Net (Patient Education from the American Society for Clinical Oncology): CLL www.cancer.net/cancer-types/leukemia-chronic-lymphocytic-cll

3. Leukemia & Lymphoma Society: CLL www.lls.org/leukemia/chronic-lymphocytic-leukemia

4. National Comprehensive Cancer Network: CLL Guideline for Patients https://www.nccn.org/patients/guidelines/content/PDF/cll-patient.pdf

5. Patient Power: CLL https://patientpower.info/chronic-lymphocytic-leukemia/

Instructions to Obtain Credit Learning Objectives

• Address gaps in patient-provider knowledge and perceptions about treatment options for chronic lymphocytic leukemia (CLL)

• Implement resources to engage patients in shared decision-making about CLL treatment

• Foster collaborative discussions between patients and providers on guidelines and recent clinical evidence to guide personalized treatment planning for CLL

Joint Accreditation StatementIn support of improving patient care, PRIME® is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Interprofessional TeamsThis activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

Physician Credit Designation StatementPRIME® designates this Enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Physician Assistant Credit Designation StatementPRIME® has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit. PAs should only claim credit commensurate with the extent of their participation.

Nurse Practitioner Accreditation StatementPRIME Education is accredited by the American Association of Nurse Practitioners as an approved provider of nurse practitioner continuing education. Provider number: 060815. This activity is approved for 1.0 contact hour (which includes 0.35 hour of pharmacology).

Pharmacy Credit Designation StatementThis Application-based activity has been approved for 1.0 contact hour (0.1 CEUs) by PRIME® for pharmacists. The Universal Activity Number for this activity is JA0007144-0000-21-164-H01-P. Pharmacy CE credits can be submitted to the NABP upon successful completion of the activity by providing your NABP ID & DOB, which must be submitted within 60 days of completion. Pharmacists with questions can contact NABP customer service (help@nabp.pharmacy).

Nursing Credit Designation StatementPRIME® designates this activity for 1.0 contact hour.

Release Date: September 1, 2021

Thank you for presenting this patient education program titled “Engaging Patients in Chronic Lymphocytic Leukemia Care: A Collaborative Toolkit for Clinical Teams” in your clinic. We hope these materials will help increase patients’ engagment in their health care decisions and care plans for years to come.

1. Complete the activity in its entirety.2. Visit PRIME®’s Credit Center at

www.primeinc.org/credit.3. Enter program code 22PR212.4. Upon completion of the learner assessment tools,

you will be able to print or save an electronic copy of your certificate.

www.primeinc.orgThis activity is provided by PRIME® Education. There is no fee to participate. This activity is supported by educational grants from Adaptive Biotechnologies, Genentech, and Pharmacyclics, an AbbVie Company.

Engaging Patients in Chronic Lymphocytic Leukemia Care: A Collaborative Toolkit for Clinical Teams

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Open the session by sharing with the audience why you are excited to be with them and why this session will be helpful. Encourage an open dialogue throughout the program. Let participants know they can ask questions at any time.

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Non-Hodgkin lymphoma (NHL) is a type of lymphoma that affects approximately 77,000 people per year. There are multiple subtypes of NHL, including T-cell lymphomas and B-cell lymphomas. Among B-cell lymphomas, some cancers tend to grow more slowly (indolent) while others progress more quickly (aggressive). Chronic lymphoblastic leukemia (CLL) and small lymphocytic lymphoma (SLL) are types of indolent B-cell lymphoma that are often described together due to their close similarity. Each year, approximately 21,000 adults will be diagnosed with CLL/SLL.

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Review the preliminary diagnostic tests commonly used for CLL.

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Prognostic factors are features of CLL that are helpful in predicting response to treatment. As such, they are useful in choosing which treatments may be the best options for individual patients with CLL.

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There are several staging systems for CLL. The most common staging system, called the Rai Clinical Staging Systems, classifies CLL into one of 5 stages (stage 0 through stage IV). Staging is important for monitoring CLL and determining when to start therapy.

Open dialogue about questions or concerns that patients may have about their diagnosis, stage, prognostic factors, or symptoms that may be associated with their CLL.

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The decision of when to begin treatment for CLL depends on the stage of the disease, the presence of symptoms, and other factors. Many patients with early-stage CLL can be managed with a “watch and wait” strategy. This approach requires routine clinic visits with blood work and a physical exam to monitor disease symptoms. There are several indications for starting treatment with CLL medications, as listed here.

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Over time, treatment choices for CLL have improved significantly. Current strategies involve so-called targeted therapies, which target a biologic process that is specific to CLL. Targeted therapies can be used alone or in combination with other medications.

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Several new targeted therapies have been approved for the treatment of CLL in recent years. Targeted therapies can be used alone (monotherapy) and in combination with other medications. With a growing number and variety of targeted therapies, it is important to develop a treatment plan that best suits the goals and preferences of individual patients with CLL.

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Introduce the concept of continuous versus time-limited therapy for CLL. The discussion of the benefits and limitations of each approach continues on the following slide.

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With multiple choices for treatment, it is important to select a treatment plan that works best for each patient. Some of the considerations for treatment involve the length of treatment, how therapy is given, and what side effects are associated with therapy.

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Several treatment options are available for patients whose CLL progresses after responding to earlier therapy (relapse) or whose disease does not respond to their current medication (refractory). As with first-line therapy, the choice of treatment for relapsed/refractory CLL depends on prognostic factors as well as the patient’s treatment goals and preferences.

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Treatment options for CLL are continuing to evolve. One type of therapy that shows benefits in other types of blood cancers is called chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell therapy is also being studied for the treatment of patients with CLL.

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Clinical trial participation is crucial to improving the treatment of CLL. There are different phases of clinical trials available for almost every stage of disease (ie, newly diagnosed, refractory, relapsed) that aim to provide different results.

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In the next section, participants will be guided in a discussion to identify and prioritize their goals for therapy. First, open the floor for patients to ask questions or raise their concerns about the different treatment options available for CLL.

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When talking to their doctor, patients with CLL should share their preferences and concerns about their treatment options; this way, patients and providers can agree on a therapy that will not only fit clinical needs and target their cancer, but will also fit each patient’s lifestyle and be easy or convenient for them to take.

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With so many treatment options, shared decision-making helps patients and providers find the best option for each patient. Explain to patients that their opinion/voice is very important and that through shared decision-making, they can talk about what is important to them with their team, learn more about CLL, understand what the available and emerging treatment options are, and find a plan that fits their needs.

Shared decision-making is a continuous process. Explain to patients that their CLL can change over time, so it is important that they always share with their CLL team if they notice any changes or worsening symptoms—even if they don’t think it is related or important!

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Talking to a health care provider may be intimidating for a patient, but it doesn’t have to be! These are some tips to help patients communicate better with their team.

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Make sure that patients know they are NOT alone in this journey. Let them know that they may come to you with questions at any time, and be willing to point them in the direction of others who have experienced the CLL journey firsthand. Be sure to mention these helpful online resources where they might find more information as well as online support and advocacy groups.

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Reiterate the importance of the patient’s role in their own decisions, treatments, and recovery.

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COVID-19 is a major concern amongst many patients with CLL. This study provides a basis of the characteristics of patients with CLL that contract the COVID-19 virus as well as the outcomes and factors influencing their outcomes.

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The overall response rate for patients with CLL to the COVID-19 vaccine is low at just under 40%. This varies based on treatment status and other disease and patient-related factors. Vaccination when appropriate is still highly recommended for patients with CLL.

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Address some of the very common questions patients with CLL have about COVID-19 and the vaccine.

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In case of a shy audience, share an inspirational patient story.

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