Simulation in oncologic care: Advancing evidence-based decisions in the management of metastatic castration resistant prostate cancer.

Abstract

322 Background: A considerable proportion of prostate cancer cases among men progress to mCRPC. As a result, appropriate treatment selection and sequencing is crucial to maximizing patient outcomes. A study was conducted to determine if simulation-based educational interventions to address underlying clinical practice gaps could improve clinical decisions of oncologists in the management of mCRPC. Methods: A cohort of US-practicing oncologists who participated in online simulation-based education was evaluated. The intervention consisted of two cases presented in a platform that allowed learners to assess the patient and choose from an extensive database of diagnostic and treatment possibilities matching the scope and depth of actual practice. Clinical decisions made by participants were analyzed using a decision engine, and instantaneous clinical guidance employing current evidence-based and expert faculty recommendations was provided at each decision point. Participant decisions before and after clinical guidance were compared using a 2-tailed paired T-test to provide p-values for assessing the impact of simulation-based education on the clinical decisions made by participants between 2/25/2014 and 9/12/2014. Results: The assessment sample consisted of 107 oncologists who made clinical decisions within the simulation. As a result of clinical guidance, significant improvements were observed in: a) Selection of an evidence-based regimen that included mCRPC targeted therapy (17%, p = 0.027) and treatment for bone metastases (26%, p < 0.0001), in an individual with a 6-year history of prostate cancer whose disease presented with bone metastasis; and b) Starting a bone resorption inhibitor (25%, p < 0.001) and switching mCRPC therapies (28%, p < 0.001) in a patient whose PSA levels were rising despite treatment. Conclusions: This study showed improvements in clinical decisions of oncologists in selecting evidence-based therapeutic regimens for patients with mCRPC. This study demonstrates that online, simulation-based instruction can result in an increase in appropriate clinical decisions, and may play a role in improving the quality of care and patient outcomes.