Talking about risk in the context of genomic tests (TARGET): development and evaluation of an educational programme for clinicians

Purpose: Gene expression profiling (GEP) test scores calculate risks of recurrence and likely benefit of adjuvant chemotherapy in ER positive, HER2 negative, early stage breast cancer. As health literacy and numeracy skills in the general population are poor, healthcare professionals (HCPs) require a wide repertoire of communication skills to explain clearly risk of recurrence scores (RSs) and uncertainty. We developed and evaluated an educational program for HCPs discussing GEP test results and adjuvant treatment. Methods: Eight hour workshops contained elements aimed at improving knowledge, communication skills, and self-awareness; these included:- the science underpinning GEP tests, an interactive risk psychology lecture, exercises and facilitated group discussions regarding 7 filmed scenarios involving discussions about high, intermediate and low RSs. Attendees were recorded explaining RSs with patient simulators pre and post workshop. Researchers blinded to time-point, analysed recordings using a study specific scoring system. Primary objective outcomes were improvements post workshop in HCPs’ competence and confidence when communicating 17 pre-specified key information areas. We estimated odds ratios (OR) using conditional logistic regression to compare pre and post workshop scores. Results: 65 HCPs attended. Objective analyses revealed significant positive shifts post-workshop which included explaining:- GEP tests (OR=2.98; 95% CI, 1.38 to 6.42; P=.001), recurrence RSs (OR=3.99; 95% CI, 1.72 to 9.25; P<.001), benefits of chemotherapy (OR= 3.99; 95% CI, 1.82 to 8.75; P<.001; and harms OR=2.31; 95% CI, 1.37 to 3.92; P<.001) using jargon free language (OR=5.29; 95% CI, 2.27 to 12.35; P<.001). Patient simulator assessments also showed significant improvements as did HCPs’ self-assessments and ratings of their self-confidence when discussing different GEP tests with diverse patient types (P<.001). Conclusion: These short, intensive, interactive TARGET workshops significantly improved HCPs’ communication about GEP results in ways likely to promote more informed decision-making by patients about chemotherapy.