Development of a QStreamKnowledge Translation on Referral for Ovarian Cancer for Medical and

Gynaecological Oncologists

The Team

• Assoc Prof Tim Shaw (Usyd)

• Pamela Provan (SW-TCRC)

• Dr Tracy Robinson (Usyd)

• Anna Janssen (Usyd)

• Professor Anna de Fazio(SW-TCRC)

• Assoc Prof Judy Kirk (SW-TCRC)

• Dr Annabel Goodwin (Catalyst)

• Dr Kathy Tucker (POW)

Ovarian Cancer

• Significant proportion of risk – germline mutations in BRCA1 and BRCA2

• Early data suggest BRCA mutation associated with longer survival rates & generally favourable responses to platin based chemotherapy

• Strong rationale for risk reduction

• State guidelines (EviQ) on referral for genetic testing updated 2012

Ovarian Cancer

• Guidelines alone not effective for disseminating new knowledge (Grimshaw et al., 2004)

• New knowledge does not equate with behaviour change

• Need innovative approaches to dissemination of new and updated guidelines

Qstream

Evidence-based (developed at Harvard)

Online (repeated and spaced) with impressive results (12 RCA’s)

Case based multiple choice questions (well received by busy clinicians)

Little time to complete & reaches large numbers

Instant feedback on performance and further information

Qstream

Qstream

Evidence-based (developed at Harvard)

Impressive published results (12 RCA’s)

Well received by clinicians

Takes little time to complete

Can reach large numbers at low cost

Instant feedback on performance

Study Aims

• Increase and / or reinforce clinician knowledge about latest evidence re genetic assessment and consideration of testing for particular types of ovarian cancer

Examine the impact of the program on the referral patterns of participating clinicians

Assess QStream’s utility and acceptability with clinicians working in high work volume environments

Methods

• Quasi experimental design

• Semi structured interviews & content analysis (N=12).

• KinTrack data (compare number of women diagnosed with number referred pre and post course) at 3 referral sites

Results

29 clinicians enrolled (21 actually commenced)

17 (81%) completed all aspects

5 registrars

4 med oncs

4 gynae onc staff specialists

2 gynae onc fellows

2 nurses

12 participated in interviews

Thematic Analysis

• Three broad themes:

Knowledge change

Curriculum and format (QStream platform)

Changes in referral patterns

Quotes (Knowledge Change)

• A lot of the time we don’t actually learn why you would refer someone for genetics so that was good and there were several things that I thought we shouldn’t do and it turned out we should

• Interestingly enough, one of my colleagues was not aware of the new recommendations for screening … so it kind of prompted an interesting offline conversation and we went and looked up an article that supported that recommendation

Quotes (Curriculum & Format)

• It fitted very well with my schedule. I think it can sometimes be tough to sort of take the time to sit down at a desk at home to do work. This actually worked well

• More than anything, It’s just a good learning tool … And because you’re answering the question you’re actually remembering it more than if you were just reading

• And because it comes in small amounts, like you can do five or ten minutes of, you know, after a 12 hour day, you can still do that

Quotes (Changes in referral)

• At the back of my mind I will know when and who needs it

• I would now refer people at a much lower threshold than I would before

• I think at least its given me enough confidence to know whether to refer someone or not

• I think it taught me a lot about who I should be sending patients to or what else I should be thinking about

Limitations

• Small number participants – precluded statistical analysis

• 19% attrition rate (no formal CME points)

• Challenge demonstrating behaviour change –cannot match referrals with individual participants

Conclusions

• QStream significant advantages when working with time poor clinicians

• Well accepted format

• May need to supplement Qstream with implementation approaches such as audit and feedback

• More work needed to identify ideal spacing intervals