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Innovations conference 2014   dr tracy robinson development of a q stream knowledge translation program
Development of a QStream 
Knowledge Translation on Referral 
for Ovarian Cancer for Medical and 
Gynaecological Oncologists
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)
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
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
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
Qstream
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
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
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
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
Thematic Analysis 
• Three broad themes: 
Knowledge change 
Curriculum and format (QStream 
platform) 
Changes in referral patterns
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
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
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
Limitations 
• Small number participants – precluded 
statistical analysis 
• 19% attrition rate (no formal CME points) 
• Challenge demonstrating behaviour change – 
cannot match referrals with individual 
participants
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

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Innovations conference 2014 dr tracy robinson development of a q stream knowledge translation program

  • 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
  • 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

Editor's Notes

  1. In this context ovarian cancer includes ovarian, fallopian tube and primary peritoneal BRCA 1 Cumulative risk by age 70 is 40% BRCA2 Cumulative risk by age 70 is 20% Updated that women with high grade invasive ovarian, fallopian tube or primary peritoneal cancer (non mucinous) and aged less than or equal to 70 should be considered for testing – or at any age when family history of breast or ovarian cancer
  2. Several RCTs demonstrate improved retention of learned material, positive impact on practice behaviour and even patient outcomes
  3. Two intervention sites and one Control – compared the number of women diagnosed with the number referred over a 12 month period
  4. Over the past five years, on average 23% of women diagnosed with ovarian cancer were referred for genetic assessment and consideration of testing at Westmead Hospital. The study hypothesises that subsequent to the QStream education program, referral rates of women will increase to 35% at Westmead. To ensure sufficient power and demonstrate a minimum 12% increase in referrals, the study will require 100 women to be seen by participating clinicians. For this reason, two sites were included (Westmead and Royal Prince Alfred Hospitals)