PRACTICE GAPS AND BARRIERS TO OPTIMAL MANAGEMENT OF MULTIPLE MYELOMA PATIENTS : RESULTS FROM A MIXED-METHODS STUDY IN 8 EUROPEAN COUNTRIES.
(Abstract release date: 05/18/17)
EHA Library. Mohty M. 05/18/17; 182674; PB1960
Dr. Mohamad Mohty
Contributions
Contributions
Abstract
Abstract: PB1960
Type: Publication Only
Background
Previous studies have identified gaps and barriers in Multiple Myeloma (MM) patient care, especially in relation to treatment decision making. However, only few studies have aimed at better understanding the practice gaps, from the healthcare providers’ perspectives, with the purpose to investigate the root causes of those gaps and find solutions to alleviate the challenges.
Aims
We conducted a study to identify the practice gaps and challenges in the diagnosis, treatment and management of MM patients, as experienced and reported by medical oncologists, haematologists and hemato-oncologists (HEM) and oncology nurses (NU) in 8 European countries between February 2016 and June 2016.
Methods
This mixed methods ethics-approved study included exploratory semi-structured interviews (phase 1) designed to generate in-depth discussion around challenges in the diagnosis, treatment and management of MM, followed by a quantitative online survey (phase 2) designed to validate the findings from the interviews with a larger sample. Practice gaps were identified through combined analysis of data from the in-depth interviews and online surveys.
Results
A total of 364 participants (HEM = 281, NU = 83) from France (n= 58), Germany (n=58), Russia (n=41), Spain (n=58), Italy (n=50), the UK (n=58), the Netherlands (n=16), and Belgium (n=25) participated in this study. Thirty-nine (39) interviews were conducted (HEM = 28, NU=11) and 325 participants completed the online survey (HEM=253, NU=72). A majority (79%) of the sample had more than 10 years of clinical practice experience and over a third (39%) had over 20% of MM patients in their patient caseload. Three key findings were identified in the management of MM patients: 1) challenges in managing treatment side-effects. Forty percent (40%) of HEM reported lack of skills in managing cardiovascular side effects or symptoms. Over a third of HEM reported difficulties in managing fatigue (40%), skin toxicities (35%) or peripheral neuropathy (34%). NU reported being challenged by the management of renal insufficiency as a side effect or symptom (46%), peripheral neuropathy (36%), thrombosis (37%), and skin toxicities (33%). Additionally, 2) NU reported challenges in communicating with patients and educating them around their disease, especially in relation to treatment outcomes and long term side effects. For example, 51% of NU reported a lack of skills discussing sexual issues as consequences of the disease/treatment. Finally 3) there was a large variability across countries in the guidelines followed by HEM and NU for the treatment and management of MM patients. Detailed results, including country-specific analyses and investigation of the practice gaps’ causalities, will be presented.
Conclusion
These findings provide real-life recent evidence of the challenges of HEM and NU in relation to specific aspects of the management of patients with MM with 3 main areas, challenges in managing side effects, communication with patients and leverage of guidelines which show differences between HEM and NU but also between countries. The findings support the needs for the development of tailored clinical tools, educational activities and performance improvement interventions, adapted to the local context at a country level. Efforts should aim to address those current challenges before new therapies, such as immunotherapies, become available. These new agents, with their own specific safety and side effect profiles, are likely to add to the challenges already experienced by health care providers in their management of patients with MM.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple Myeloma, Adverse reaction
Abstract: PB1960
Type: Publication Only
Background
Previous studies have identified gaps and barriers in Multiple Myeloma (MM) patient care, especially in relation to treatment decision making. However, only few studies have aimed at better understanding the practice gaps, from the healthcare providers’ perspectives, with the purpose to investigate the root causes of those gaps and find solutions to alleviate the challenges.
Aims
We conducted a study to identify the practice gaps and challenges in the diagnosis, treatment and management of MM patients, as experienced and reported by medical oncologists, haematologists and hemato-oncologists (HEM) and oncology nurses (NU) in 8 European countries between February 2016 and June 2016.
Methods
This mixed methods ethics-approved study included exploratory semi-structured interviews (phase 1) designed to generate in-depth discussion around challenges in the diagnosis, treatment and management of MM, followed by a quantitative online survey (phase 2) designed to validate the findings from the interviews with a larger sample. Practice gaps were identified through combined analysis of data from the in-depth interviews and online surveys.
Results
A total of 364 participants (HEM = 281, NU = 83) from France (n= 58), Germany (n=58), Russia (n=41), Spain (n=58), Italy (n=50), the UK (n=58), the Netherlands (n=16), and Belgium (n=25) participated in this study. Thirty-nine (39) interviews were conducted (HEM = 28, NU=11) and 325 participants completed the online survey (HEM=253, NU=72). A majority (79%) of the sample had more than 10 years of clinical practice experience and over a third (39%) had over 20% of MM patients in their patient caseload. Three key findings were identified in the management of MM patients: 1) challenges in managing treatment side-effects. Forty percent (40%) of HEM reported lack of skills in managing cardiovascular side effects or symptoms. Over a third of HEM reported difficulties in managing fatigue (40%), skin toxicities (35%) or peripheral neuropathy (34%). NU reported being challenged by the management of renal insufficiency as a side effect or symptom (46%), peripheral neuropathy (36%), thrombosis (37%), and skin toxicities (33%). Additionally, 2) NU reported challenges in communicating with patients and educating them around their disease, especially in relation to treatment outcomes and long term side effects. For example, 51% of NU reported a lack of skills discussing sexual issues as consequences of the disease/treatment. Finally 3) there was a large variability across countries in the guidelines followed by HEM and NU for the treatment and management of MM patients. Detailed results, including country-specific analyses and investigation of the practice gaps’ causalities, will be presented.
Conclusion
These findings provide real-life recent evidence of the challenges of HEM and NU in relation to specific aspects of the management of patients with MM with 3 main areas, challenges in managing side effects, communication with patients and leverage of guidelines which show differences between HEM and NU but also between countries. The findings support the needs for the development of tailored clinical tools, educational activities and performance improvement interventions, adapted to the local context at a country level. Efforts should aim to address those current challenges before new therapies, such as immunotherapies, become available. These new agents, with their own specific safety and side effect profiles, are likely to add to the challenges already experienced by health care providers in their management of patients with MM.
Session topic: 14. Myeloma and other monoclonal gammopathies - Clinical
Keyword(s): Multiple Myeloma, Adverse reaction
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