Optimizing Management of AML: Insights from a Community-Based Quality Improvement Initiative

• Published in: Blood 2023-11, Vol.142 (Supplement 1), p.7278-7278
• Main Authors: Zeidner, Joshua F., Sullivan, Shelby, Carter, Jeffrey, Heggen, Cherilyn
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood-2023-173038

Background There has been groundbreaking progress in the molecular diagnosis, risk stratification, and treatment landscape for acute myeloid leukemia (AML), allowing providers to tailor a personalized therapy approach for individual patients. Despite these advances, many barriers to optimal AML treatment exist in integrating targeted therapies, selecting guideline-aligned treatments and managing adverse events. To address these challenges, we conducted a quality improvement (QI) study in community oncology clinics to assess current practice patterns and develop strategies to overcome barriers to optimal care for patients with AML. Methods The QI initiative comprised baseline provider surveys and pre- and post-surveys of providers participating in small-group, team-based audit-feedback (AF) sessions. Survey questions were designed to assess knowledge, confidence, and experiences with targeted therapies for AML. Care teams from each clinic, along with an expert AML physician, participated in AF sessions to (a) assess system-specific practice gaps identified via the provider surveys, (b) prioritize areas for improvement, and (c) develop action plans for addressing root causes. Between 1/2022-6/2022, 104 hematology/oncology providers completed baseline surveys and 54 care team members from the enrolled clinics participated in the AF sessions (Table 1). Results Provider Surveys: Providers' top reported challenges encountered in managing patients with AML were individualizing treatment plans (33%) and supportive care counseling (21%). Moreover, the most challenging issue encountered in selecting therapies for patients with AML was selecting optimal therapies for individual patients (27%). Factors considered most important in treatment decision-making, in addition to clinical guidelines, included effects on quality of life (51%) and treatment effectiveness (51%). Additionally, top parameters guiding treatment decision-making include age (63%) and karyotype/molecular abnormalities (60%). Clinicians reported the most difficulty in managing myelosuppression (34%) associated with novel AML therapies. When asked their top barriers to engaging patients with AML in shared decision-making, providers reported patient's low health literacy (29%) and not enough time to engage in SDM (25%). AF Sessions: Providers participating in the small group AF sessions reported testing for and interpreting results of molecular and genetic features (30%) and individualizing treatment pla