Patients and their caregivers who partner with their clinical teams to understand chronic lymphocytic leukemia (CLL) and adopt personalized treatment plans are more satisfied and achieve better outcomes with their care. How can clinical teams engage their patients to achieve this?

Shared decision-making (SDM) is one approach that can help. At the core, SDM occurs when patients and providers have an open discussion regarding the patient’s care, and together make treatment decisions that reflect the patient’s treatment goals and preferences, as well as the provider’s professional experience and expert guidance regarding available clinical evidence.

As the landscape of CLL treatment evolves, it is critical for providers to stay up-to-date on emerging best practices and to convey this new information to patients. By guiding you through the key steps of SDM, this practical toolkit is designed to help you help your patients with CLL to stay educated, empowered, and engaged in their care through group educational sessions or one-on-one patient education counseling.

Regardless of when or how you choose to host these collaborative learning sessions, this guide supports you in creating a comfortable, nonjudgmental setting in which patients and their caregivers are able to ask questions, share concerns, and learn from each other’s experiences. Patients should be encouraged to participate throughout in order to facilitate important discussion, and enable the speaker to tailor the information to the patients’ baseline knowledge about CLL.

Ultimately, the key goal of this toolkit is to encourage patients with CLL to be active participants in their health care decisions and care plan through SDM, helping build a strong partnership with their CLL care teams for higher treatment satisfaction and better treatment outcomes.

Easy-to-read content centered on key CLL topics, including the stages of CLL, when to start therapy, current treatment options, and SDM with the CLL care team

The patient-friendly slide deck features:

Speaker notes to help you or other members in your clinical team deliver the information using language that’s easy for patients and caregivers to understand

Discussion questions to keep the educational sessions interactive and hear your patients’ experiences of living with CLL, questions or concerns regarding their treatment, and preferences for their care

For additional CME/CE activities in CLL and other disease states, visit www.primeinc.org.

www.primeinc.orgThis activity is provided by PRIME® Education. There is no fee to participate. This activity is supported by an educational grant from Abbvie, Inc.

PATIENT-CENTERED CARE IN CHRONIC LYMPHOCYTIC LEUKEMIA: A PRACTICAL TOOLKIT FOR CLINICAL TEAMS

Overview

1. American Cancer Society: CLL www.cancer.org/cancer/chronic-lymphocytic-leukemia.html

2. Cancer.Net (Patient Education from the American Society for Clinical Oncology): CLL www.cancer.net/cancer-types/leukemia-chronic-lymphocytic-cll

3. Leukemia & Lymphoma Society: CLL www.lls.org/leukemia/chronic-lymphocytic-leukemia

4. National Comprehensive Cancer Network: CLL Guideline for Patients https://www.nccn.org/patients/guidelines/content/PDF/cll-patient.pdf

5. Patient Power: CLL https://patientpower.info/chronic-lymphocytic-leukemia/

Additional Resources for Patient Engagement and Education

Instructions to Obtain Credit Learning Objectives

• Address gaps in patient-provider knowledge and perceptions about treatment options for CLL

• Implement resources to engage patients in shared decision-making about CLL treatment

• Foster collaborative discussions between patients and providers on guidelines and recent clinical evidence to guide personalized treatment planning for CLL

Joint Accreditation StatementIn support of improving patient care, PRIME® is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education forthe healthcare team.

Interprofessional TeamsThis activity was planned by and for the healthcare team, and learners will receive 1.0 Interprofessional Continuing Education (IPCE) credit for learning and change.

Physician Credit Designation StatementPRIME® designates this Enduring material for a maximum of 1.0 AMA PRA Category 1 Credit™. Physicians should claim only credit commensurate with the extent of their participation in the activity.

Physician Assistant Accreditation StatementPRIME® has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 1.0 AAPA Category 1 CME credit. PAs should only claim credit commensurate with the extent of their participation.

Nurse Practitioner Accreditation StatementThis activity is approved for 1.0 contact hour of continuing education (which includes 0.17 hours of pharmacology) by the American Association of Nurse Practitioners. This activity was planned in accordance with AANP Accreditation Standards and Policies. Provider number: 060815.

Pharmacist Accreditation StatementThis application-based activity has been approved for 1.0 contact hour (0.1 CEUs) by PRIME® for pharmacists. The Universal Activity Number for this activity is JA0007144-0000-20-056-H02-P. Pharmacy CE credits will be submitted electronically to the NABP upon successful completion of the activity. Pharmacists with questions can contact NABP customer service (custserv@nabp.net).

Nurse Accreditation StatementPRIME® designates this activity for 1.0 contact hour.

Case Manager Accreditation StatementThe Commission for Case Manager Certification designates this educational activity for 1.0 contact hour for certified case managers. Credits for this program are pre-approved.

Release Date: October 5, 2020

Thank you for presenting this patient education program titled “Patient-Centered Care in Chronic Lymphocytic Leukemia: A Practical Toolkit for Clinical Teams” in your clinic. We hope these materials will help increase patients’ engagment in their health care decisions and care plans for years to come.

1. Complete the activity in its entirety.2. Visit PRIME®’s Credit Center at

www.primeinc.org/credit.3. Enter program code 11PR201.4. Upon completion of the learner assessment tools,

you will be able to print or save an electronic copy of your certificate.

www.primeinc.orgThis activity is provided by PRIME Education. There is no fee to participate. This activity is supported by an educational grant from Gilead Sciences, Inc.

PATIENT-CENTERED CARE IN CHRONIC LYMPHOCYTIC LEUKEMIA: A PRACTICAL TOOLKIT FOR CLINICAL TEAMS

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Open the session by sharing with the audience why you are excited to be with them and why this session will be helpful. Encourage an open dialogue throughout the program. Let participants know they can ask questions at any time.

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Non-Hodgkin lymphoma (NHL) is a type of lymphoma that affects approximately 77,000 people per year. There are multiple subtypes of NHL, including T-cell lymphomas and B-cell lymphomas. Among B-cell lymphomas, some cancers tend to grow more slowly (indolent) while others progress more quickly (aggressive). Chronic lymphoblastic leukemia (CLL) and small lymphocytic lymphoma (SLL) are types of indolent B-cell lymphoma that are often described together due to their close similarity. Each year, approximately 21,000 adults will be diagnosed with CLL/SLL.

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Review the preliminary diagnostic tests commonly used for CLL.

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Genetic tests are performed to detect changes in the genes and chromosomes of CLL cells. The most common types of genetic tests are listed here. For each of these, the test can be performed using a blood or bone marrow sample.

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Prognostic factors are features of CLL that are helpful in predicting response to treatment. As such, they are useful in choosing which treatments may be the best options for individual patients with CLL.

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There are several staging systems for CLL. The most common staging system, called the Rai Clinical Staging Systems, classifies CLL into one of 5 stages (stage 0 through stage IV). Staging is important for monitoring CLL and determining when to start therapy.

Open dialogue about questions or concerns that patients may have about their diagnosis, stage, prognostic factors, or symptoms that may be associated with their CLL.

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The decision of when to begin treatment for CLL depends on the stage of the disease, the presence of symptoms, and other factors. Many patients with early-stage CLL can be managed with a “watch and wait” strategy. This approach requires routine clinic visits with blood work and a physical exam to monitor disease symptoms. There are several indications for starting treatment with CLL medications, as listed here.

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Over time, treatment choices for CLL have improved significantly. Current strategies involve so-called targeted therapies, which target a biologic process that is specific to CLL. Targeted therapies can be used alone or in combination with other medications.

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Several new targeted therapies have been approved for the treatment of CLL in recent years. Targeted therapies can be used alone (monotherapy) and in combination with other medications. With a growing number and variety of targeted therapies, it is important to develop a treatment plan that best suits the goals and preferences of individual patients with CLL.

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When patients are ready to start treatment for CLL, the choice of therapy depends on prognostic factors, including the presence of key mutations. Clinical features such as patient age and the presence of comorbidities may also influence the choice of therapy.

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Introduce the concept of continuous versus time-limited therapy for CLL. The discussion of the benefits and limitations of each approach continues on the following slide.

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With multiple choices for treatment, it is important to select a treatment plan that works best for each patient. Some of the considerations for treatment involve the length of treatment, how therapy is given, and what side effects are associated with therapy.

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Several treatment options are available for patients whose CLL progresses after responding to earlier therapy (relapse) or whose disease does not respond to their current medication (refractory). As with first-line therapy, the choice of treatment for relapsed/refractory CLL depends on prognostic factors as well as the patient’s treatment goals and preferences.

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Treatment options for CLL are continuing to evolve. One type of therapy that shows benefits in other types of blood cancers is called chimeric antigen receptor (CAR) T-cell therapy. CAR T-cell therapy is also being studied for the treatment of patients with CLL.

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In the next section, participants will be guided in a discussion to identify and prioritize their goals for therapy. First, open the floor for patients to ask questions or raise their concerns about the different treatment options available for CLL.

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When talking to their doctor, patients with CLL should share their preferences and concerns about their treatment options; this way, patients and providers can agree on a therapy that will not only fit clinical needs and target their cancer, but one that will also fit each patient’s lifestyle and is easy or convenient for them to take.

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With so many treatment options, shared decision-making helps patients and providers find the best option for each patient. Explain to patients that their opinion/voice is very important and that, through shared decision-making, they can talk about what is important to them with their team, learn more about CLL, understand what the available and emerging treatment options are, and find a plan that fits their needs.

Shared decision-making is a continuous process. Explain to patients that their CLL can change over time, so it is important that they always share with their CLL team if they notice any changes or worsening symptoms—even if they don’t think it is related or important!

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Talking to a health care provider may be intimidating for a patient, but it doesn’t have to be! These are some tips to help patients communicate better with their team.

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Make sure that patients know they are NOT alone in this journey. Let them know that they may come to you with questions at any time, and be willing to point them in the direction of others who might help them understand the journey as someone who has experienced it firsthand. Be sure to mention these helpful online resources where they might find more information, as well as online support and advocacy groups.

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Reiterate the importance of the patient’s role in their own decisions, treatments, and recovery.

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In case of a shy audience, share an inspirational patient story.

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