Does an online oral anti-cancer medication education program, targeted at community pharmacists improve their

knowledge and confidence in dispensing oral anti-cancer

medications?

Erica Wales

Clinical Pharmacist Wollongong Hospital

Master of Clinical Pharmacy 2014 Monash University

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Expanding number of oral anti-cancer agents1

Advantages of oral over IV anti-cancer treatment2,3

Medication Adherence4,5

Patient Education6

Pharmacist Education 7,8,9, 10, 11,12,13

1D’Amato S. Oral oncolytics: pharmacy benefit designs, trends and policy considerations. Chemotherapy advisor Jan 4, 2013 [cited 2013 Aug 10]. 2Moore S, Brandt ML. Adherence to oral therapies for cancer: helping your patients stay on course toolkit. Oncology Nurses Society 2010;4(1):263Moore S. Facilitating oral chemotherapy treatment and compliance through patient/family-focused education. Cancer Nursing 2007;30(2):112-122 4Simone A. Increased medication adherence reduces health care costs. Pharmacy Times 2013 [cited 2013 Aug 10 5Thompson AM, Dewar J. Fahey T, McCowan C. Association of poor adherence to prescribed tamoxifen with risk of death from breast cancer. ASCO Breast Cancer Symposium 2007 [cited 2013 Aug 11]. 6Society of Hospital Pharmacist of Australia. SHPA Standards of Practice for the Provision of Oral Chemotherapy for the Treatment of Cancer. Journal of Pharmacy Practice Research 2007;37(2):149-527Abbott R, Edwards S, Edwards J, Dranitsaris G, McCarthy J. Oral anti-cancer agents in the community setting: a survey of pharmacists in Newfoundland and Labrador. Canadian Pharmacists Journal. 2011;144(5):220-2268O’Bryant CL, Crandell BC. Community pharmacist’s knowledge of and attitudes towards oral chemotherapy. Journal of American Pharmacists Association. 2008;48(5):632-99Abbott R, Edwards S, Whelan M, Edwards J, Dranitsaris G. Are community pharmacists equipped to ensure the safe use of oral anticancer therapy in the community setting? Results of a cross-country survey of community pharmacists in

Canada. Journal of Oncology Pharmacy Practice. 2012;0(0):1-1110Yin H, Lonie J, Shah B, Shukla T. Pharmacists’ self-reported transfer of learning and participation in continuing education programs in social and administrative pharmacy: a pilot study. Currents in Pharmacy Teaching and Learning 2010;2:255-

260 11Allen IE, Seaman J. Learning of Demand: Online education in the United States 2009. Sloan Consortium. PO Box 1238, Newburyport, MA 12Lahti M, Hatonen H, Valimaki M. Impact of e-learning on nurses’ and student nurses knowledge, skills, and satisfaction: A systematic review and met-analysis. International Journal of Nursing Studies 2013 [cited 2013 Aug 10] 13Budzinski JW, Farrell B, Pluye P, Grad RM, Repchinsky C, Jovaisas B, Johnson-Lafleur J. An online knowledge resource and questionnaires as a continuing pharmacy education tool to document reflective learning. American Journal of

Pharmaceutical Education 2012;76(5):1-6 3

To evaluate the impact of a tailored online oral anti-cancer education package on the knowledge and confidence of community pharmacists required to dispense oral anti-

cancer agents

It is hypothesised that the development and implementation of a tailored online oral anti-cancer education program will improve the knowledge and confidence of

community pharmacists with regard to oral anti-cancer agents.

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FOCUS GROUP PROFILE

Total of SEVEN participants

SIX female and ONE male

Stage of Pharmacy Career

ONE early pharmacist

FIVE mid-career pharmacists

ONE senior pharmacist

Occupation of participants

THREE pharmacy owner/operators

TWO pharmacists-in-charge

TWO part-time pharmacists

KEY FINDINGS

Lack of knowledge/ information

Education at an undergraduate level was minimal with regard to oral anti-cancer medications.

Limited access to treatment protocols.

Concerned that their lack of knowledge is impacting on patient counselling and overall patient care

Lack of confidence

Infrequency of dispensing oral anti-cancer medications.

Consequences of incorrect information when dealing with oral anti-cancer medications.

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Number of Education Program Participants = FIFTY

Most participants reported having 2 to 5 years of Pharmacy Experience (n=25)

The approximate number of OAM dispensed each month was reported by the majority of participants as either ‘2 to 5’ or ‘5 to 10’ (n=21, 48% and n=15, 30% respectively).

The most frequently dispensed OAM was tamoxifen, followed by methotrexate and capecitabine.

88% reported not receiving adequate oncology education at the undergraduate level (n=44), but only 24% attended oncology continuing education in the last two years (n=12).

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Of the pre-assessment

knowledge based questions

an average of 60.5% were

answered correctly (range

25-100%)

42 participants did not

achieve the knowledgeable

benchmark of 80% or more

correct answers.

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The majority of participants achieved 80% or more correct answers, with two participants achieving 60% (n=48).

The mean improvement in knowledge scores was statistically significant, p-value < 0.0001 (mean difference 32.14, CI95% 23.03 – 41.25).

Comparison of knowledge demonstrated astatistically significant association between completion of the education program and the attainment of knowledge, p-value < 0.0001.

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Subgroup analysis demonstrated that the majority of participants correctly answered knowledge questions pertaining to counselling points.

Knowledge of side effects varied between 28% and 82% (n= 14 and 41) of participants depending on the question.

Similar variation was also seen for questions addressing adjuvant therapies and mechanism of action.

PRE ASSESSMENT CONFIDENCE

The most commonly reported answer was ‘No idea; it’s a guess’ (48.2%)

POST ASSESSMENT CONFIDENCE

The most commonly reported answer was ‘Moderately’ certain (48.3%)

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No idea; it's a guess 48.2%

Moderately36.6%

Very Confident

15.2%

Pre-assessment Confidence

No idea; it's a guess 12.4%

Moderately 49.2%

Very Confident

38.4%

Post-assessment Confidence

The most frequent answers pre-assessment were incorrect + ‘no idea; it’s a guess’ and correct + ‘moderately’ (n=259, 25.9% and n=251, 25.1%, respectively).

In the pre-assessment survey when participants were incorrect they were least likely to be ‘very confident’ in their response, 2.3% (n=23). When participants were correctthey were most likely to be ‘moderately’ confident (41.6%, n =251).

In the post-assessment survey the most common combinations were correct + ‘moderately’ and correct + ‘very confident’ (n=116, 46.6% and n=97, 38.8%, respectively).

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Factors influencing Knowledge

The impact of number of years practicing as a pharmacist illustrated a trend toward less experience resulting in higher scores

The number of OAM prescriptions correlated with knowledge scores

Participants who attended oncology CE achieved higher knowledge scores.

Factors influencing Confidence

Pharmacists with 10 years or more experience demonstrated more confidence both pre and post-assessment.

Participants dispensing 10 or more OAM prescriptions per month were more likely to be confident pre-assessment.

Those who attended CE they were more likely to be confident pre-assessment and this remained similar post-assessment.

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