Key Takeaways:

• Strategic, targeted educational outreach by medical oncologists can help close the gap between clinical guideline updates and real-world adoption and improve adherence to oncology pathways.
• Real-world electronic health record (EHR) data was instrumental in identifying gaps in care and improving treatment consistency for human epidural growth factor receptor 2 (HER2)-low metastatic breast cancer patients.
• EHRs deliver peer data quickly and efficiently and provide clinicians with an overview of US testing and treatment patterns.

In this interview, Jessica Paulus, ScD, vice president of real-world research at Ontada, discusses findings from the study “Improving Real-World Adoption of HER2-Low Therapies Through Targeted Educational Initiatives.” The study analyzed the effect of educational outreach on increasing and accelerating the adoption of HER2-low testing for patients with metastatic breast cancer. Paulus shares insights on the value of educational initiatives on clinical practice, explores the type of education needed to improve testing rates and close gaps in care access, and describes the role of EHR data in generating real-world evidence.

Please introduce yourself by stating your name, title, organization, and relevant professional experience.

Jessica Paulus, ScD: My name is Jess Paulus. I’m the vice president of real-world research at Ontada where I lead a scientific team that focuses on generating real-world evidence using oncology EHR data. Our particular focus is on understanding how care is delivered in community settings, including real-world patient outcomes. Today, we’re going to be talking about some of this work and where we see gaps between clinical practice guidelines and real-world practice.

Can you give some background about your study and what prompted you to undertake it?

Paulus: This study came out of an observation coming from both clinicians and our pharmaceutical manufacturing partners that HER2-low therapies were gaining a lot of traction quickly, both in terms of dissemination of information from trials and clinical practice guidelines, but there was a question about the speed of adoption in real-world community practice. We wanted to understand whether that gap was real, and if so, whether any strategic and targeted educational initiatives could help close that gap and move behavior.

HER2 testing rates were already high before the educational program. Why do you think there is still a gap in getting patients onto guideline-recommended HER2-low therapies?

Paulus: In this case, it wasn’t the biomarker testing that was the issue; it’s fairly ubiquitous for patients with breast cancer. The piece that revealed a gap was the interpretation and the action based on the testing results. HER2-low is a relatively new concept, so clinicians might not immediately connect the results to treatment eligibility. In breast cancer, it’s also the case that treatment decisions, particularly in metastatic diseases, are highly complex and path dependent. There’s often a lag between guideline updates and real-world prescribing behavior. The gap we were observing wasn’t so much about access to information, but more about translation into treatment decisions at the point of care.

What do these results tell us about the role education can play in improving adherence to oncology clinical pathways and guidelines in community practice?

Paulus: These results reinforce that education can have a clinically significant impact, particularly when educational initiatives are strategic, highly targeted, and highly embedded in the workflow of a busy medical oncologist. What allowed us to move the needle here wasn’t necessarily broad awareness. It was highly targeted educational content that was delivered by medical oncologists—by peers—clarifying what HER2-low actually means in practice, reinforcing when to use these therapies, and helping clinicians connect the results to these complex pathway-dependent treatment decisions. Education is going to work best when it’s designed and targeted to address ambiguity in real clinical workflows. That’s going to make the educational content attractive for clinicians that might be struggling with a highly evolving field in terms of treatment options.

The study used podcasts and peer expert consultations as part of the intervention. Which educational approaches seem to work best for helping oncologists adopt new treatment standards?

Paulus: I should acknowledge that we did not compare the 2 approaches directly. Instead, we imagined these different educational modalities as part of a package or a bundle. As people who are engaged in education and behavior change know, it often takes multiple modalities. For some busy medical oncologists, it might be a tool that’s embedded in the EHR. For others, it might be turning on a 10-minute podcast on the drive home. But what these 2 offerings had in common that landed with oncologists was that they were very short, accessible formats. They featured peer-to-peer learning, particularly with trusted peers who had depth and volume of experience in some of these clinical decision-making areas. And then there was direct expert input tied to real treatment decisions or real cases for the curbside connect peer-to-peer offering. What oncologists don’t need is more information. What they do need is trusted, clinically relevant, highly tailored reinforcement that can happen or can be delivered quickly. One of our takeaways is that educational offerings need to be highly embedded and easy to access in the workflow.

How can real-world EHR data help oncology practices identify gaps in care and improve treatment consistency for HER2-low metastatic breast cancer patients?

Paulus: Real-world EHR data is what enabled this type of unique work. It enabled the manifestation of a real learning health system. But I should caution that it’s not just any real-world data. The reason this worked as well as it did is that we had high quality, rapidly available data. We were able to assess the degree of testing and guideline concordant treatment using structured EHR data that was immediately available. We could deliver an analysis, a baseline state, of the nation’s testing and treatment. We could then deploy the educational initiatives and redo that testing and guideline concordant treatment analysis efficiently and quickly. When you bring all of this together, particularly with the right medical oncologist expertise, education expertise, and research expertise, it allowed us to quickly see where testing is happening but the treatment isn’t necessarily concordant, to see potential variation across providers or sites, and to track changes over time in terms of the guideline concordant treatment patterns.

Are there any final takeaways you would like to add?

Paulus: For us, this was an exciting demonstration of the ability to bring together real-world data-based analyses, to bring together the best of provider education, and to create this rapid cycle learning health environment. Using data that’s generated automatically in the workflow to test where things are, to see where improvement would be most important to tailor educational interventions based on that real-world data-based analysis, and then to follow up and do another analysis to see how we did. My hope is that we can expand this model to other disease areas and different indications because there’s so much promise in getting gaps in guideline concordant behavior much more quickly resolved.