This document describes the development and evaluation of a QStream knowledge translation program on referral for ovarian cancer. It involved 21 medical and gynecological oncologists who completed online case-based multiple choice questions. Evaluation found it increased clinician knowledge on genetic testing referral guidelines and prompted discussions. Interviews showed it was well-received and could be completed in short sessions. Some clinicians reported making referrals at lower thresholds after completing the program. While it showed promise, larger studies are needed to fully evaluate effectiveness and optimal question spacing.

2. Development of a QStream
Knowledge Translation on Referral
for Ovarian Cancer for Medical and
Gynaecological Oncologists

3. The Team
• Assoc Prof Tim Shaw (Usyd)
• Pamela Provan (SW-TCRC)
• Dr Tracy Robinson (Usyd)
• Anna Janssen (Usyd)
• Professor Anna de Fazio(SW-TCRC)
• Assoc Prof Judy Kirk (SW-TCRC)
• Dr Annabel Goodwin (Catalyst)
• Dr Kathy Tucker (POW)

4. Ovarian Cancer
• Significant proportion of risk – germline
mutations in BRCA1 and BRCA2
• Early data suggest BRCA mutation associated
with longer survival rates & generally
favourable responses to platin based
chemotherapy
• Strong rationale for risk reduction
• State guidelines (EviQ) on referral for genetic
testing updated 2012

5. Ovarian Cancer
• Guidelines alone not effective for
disseminating new knowledge (Grimshaw et
al., 2004)
• New knowledge does not equate with
behaviour change
• Need innovative approaches to dissemination
of new and updated guidelines

6. Qstream
Evidence-based (developed at Harvard)
Online (repeated and spaced) with impressive results
(12 RCA’s)
 Case based multiple choice questions (well received
by busy clinicians)
 Little time to complete & reaches large numbers
 Instant feedback on performance and further
information

7. Qstream

8. Qstream
Evidence-based (developed at Harvard)
 Impressive published results (12 RCA’s)
Well received by clinicians
Takes little time to complete
 Can reach large numbers at low cost
 Instant feedback on performance

9. Study Aims
• Increase and / or reinforce clinician knowledge about
latest evidence re genetic assessment and
consideration of testing for particular types of
ovarian cancer
Examine the impact of the program on the referral
patterns of participating clinicians
 Assess QStream’s utility and acceptability with
clinicians working in high work volume environments

10. Methods
• Quasi experimental design
• Semi structured interviews & content analysis
(N=12).
• KinTrack data (compare number of women
diagnosed with number referred pre and post
course) at 3 referral sites

11. Results
29 clinicians enrolled (21 actually commenced)
17 (81%) completed all aspects
5 registrars
4 med oncs
4 gynae onc staff specialists
2 gynae onc fellows
2 nurses
12 participated in interviews

12. Thematic Analysis
• Three broad themes:
Knowledge change
Curriculum and format (QStream
platform)
Changes in referral patterns

13. Quotes (Knowledge Change)
• A lot of the time we don’t actually learn why you
would refer someone for genetics so that was good
and there were several things that I thought we
shouldn’t do and it turned out we should
• Interestingly enough, one of my colleagues was not
aware of the new recommendations for screening …
so it kind of prompted an interesting offline
conversation and we went and looked up an article
that supported that recommendation

14. Quotes (Curriculum & Format)
• It fitted very well with my schedule. I think it can
sometimes be tough to sort of take the time to sit
down at a desk at home to do work. This actually
worked well
• More than anything, It’s just a good learning tool …
And because you’re answering the question you’re
actually remembering it more than if you were just
reading
• And because it comes in small amounts, like you can
do five or ten minutes of, you know, after a 12 hour
day, you can still do that

15. Quotes (Changes in referral)
• At the back of my mind I will know when and who
needs it
• I would now refer people at a much lower threshold
than I would before
• I think at least its given me enough confidence to
know whether to refer someone or not
• I think it taught me a lot about who I should be
sending patients to or what else I should be thinking
about

16. Limitations
• Small number participants – precluded
statistical analysis
• 19% attrition rate (no formal CME points)
• Challenge demonstrating behaviour change –
cannot match referrals with individual
participants

17. Conclusions
• QStream significant advantages when working
with time poor clinicians
• Well accepted format
• May need to supplement Qstream with
implementation approaches such as audit and
feedback
• More work needed to identify ideal spacing
intervals