Pathway Use Beyond the Unidimensional Treatment Decision

In a presentation at the 2023 Clinical Pathways Congress with the Cancer Care Business Exchange, Stephen B. Edge, MD, vice president of System Quality and Outcomes, Roswell Park Comprehensive Cancer Center, provides an overview of the clinical pathways at Roswell Park and how pathways can be used beyond guideline adherence.

Because having comprehensive in-house pathways proved to be unsustainable due to limited faculty time availability, Roswell Park joined the Elsevier pathways program called ClinicalPath. The pathways are used across the Roswell Park care network, which includes community practices and hospital affiliations.

The pathways are included in the daily workflow when providers interact with patients. Patients are made aware that the institution uses pathways, and that the pathways help guide the selection of new treatment decisions. ClinicalPath documents the status of care during continuation of care, and the platform is integrated into the electronic health record (EHR), including the scheduling systems. ClinicalPath automatically adds notes to the EHR to add pathways information into clinic notes. Treatment selection is also directly linked to order sets as part of this integration.

Roswell’s Park’s approach to off-pathway care is having a post-hoc review of adherence to the pathways and an “adjudication” for any off-pathway care and the reasons behind that choice. However, this review does not delay the care for the patient or increase work for the provider.

According to Dr Edge, there are several benefits to the use of clinical pathways beyond decision-making. For example, pathways can increase awareness of clinical trials and advanced therapy options for providers and patients. At Roswell Park, trials that are open at Roswell are embedded in pathways and are presented to providers depending on the patient’s presentation. In addition, pathways can be used to rapidly identify a certain number of patients with specific case presentations/demographics to support trial openings and grant submissions. So far, Roswell Park has used this tool in appropriate cases of patients with diffuse large B-cell lymphoma and multiple myeloma.

Another benefit of pathways is the overall improved patient experience, said Dr Edge. At Roswell, patient education and their participation in treatment planning is emphasized. Patients are told about pathways and work with doctors to define their best treatment options. In addition, patients are given written documentation that provides information on the extent of their cancer, treatment plan, side effects, and more.

Dr Edge also stated that pathways can be used to help identity patients with advanced cancer that should be directed toward goal-concordant care and hospice care. He views this as another opportunity to engage with and educate patients. At Roswell Park, they have seen an increase in goals of care notice that are pathways-based. They are also working with Dr Finly Zachariah at City of Hope to validate a tool to better predict short-term survival.

Looking ahead to the future of clinical pathways, Dr Edge suggests that providers should aim to improve screening processes, as doing so would help improve survivorship. “We shouldn’t have wonderful lung cancer treatment programs—we should have wonderful lung cancer screening programs,” said Dr Edge.