Evaluation of a training intervention for primary care providers to prepare patients for cancer discussions with their oncologists

We examined the impact of an online training intervention, “Preparing Patients for Cancer Treatment Discussions,” on primary care providers' knowledge, attitudes/beliefs, and communication/referral behavior. We partnered with Clinical Directors Network (CDN), Florida Academy of Family Physicians, and U.S. Residency Program Directors to recruit primary care providers (MDs, DOs, NPs, and PAs), Family Medicine residents, Internal Medicine residents and Geriatric fellows. The 1-hour, asynchronous online training was hosted by three faculty members: a primary care provider, radiation oncologist, and cancer clinical trials expert. Participants engaged in simulated patient and clinical scenarios to practice communication about oncology referrals and cancer clinical trials. Pre- and post-training surveys measured knowledge, attitudes, beliefs, and willingness to discuss trials. Further, a 3-month follow-up survey measured the sustained impact of the training on communication behavior about clinical trial referrals. 135 primary care providers (91 residents, 44 practicing clinicians) participated in the training intervention (84% retention at 3-month follow-up). Knowledge improved from a mean of 51.8% to 82.4% correct ( p <.001) immediately after training and was sustained with a mean score of 77.7% correct ( p <.001) at 3-month follow-up. Mean belief scores concerning the primary care provider's role in assisting patients with decisions about clinical trials increased from 4.1 to 4.6 (1-5 scale; p<.001) immediately following training. This improvement was sustained at a score of 4.5 (p<.001) during the 3-month follow-up. Additionally, mean scores for the willingness to communicate about clinical trials increased from 4.3 to 4.6 (1-5 scale; p<.001) immediately after training. This improvement was sustained at a score 4.5 (p<.001) during the 3-month follow-up. Behavior measures increased significantly at 3-month follow-up. Providers were asked the percentage of patients they educated about receiving treatment with a cancer clinical trial and encouraged to inquire about receiving treatment from a cancer clinical trial prior to making a referral. Education (15.1% to 52.9%) and inquiry encouragement (17.6% to 62.4%) both increased ( p <0.001). Providers were asked the same questions regarding patients that returned after their oncology visit to discuss treatment options. Education (13.9% to 49.5%) and inquiry encouragement (20.7% to 47.8%) both increased significantly ( p <0.001). Significant improvements in knowledge, attitudes, beliefs, communication and referral behavior demonstrate the online course was effective. Future plans for dissemination and sustainability include integrating the online course into curricula for medical and nursing education.