Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

Abstract

Background Pathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care. Methods All patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals, and system level were extracted from each study. Results Out of 13,847 search results, we selected 158 articles eligible for full text assessment. One hundred fifty studies were excluded and the remaining eight studies represented 4786 patients. Most studies were conducted in secondary/tertiary care. Length of stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (weighted mean difference (WMD)): − 2.75, CI: − 4.67 to − 0.83) and gynecological cancer (WMD: − 1.58, CI: − 2.10 to − 1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups. Conclusions Despite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favor of cancer care pathways. Systematic review registration PROSPERO CRD42017057592.

The impact of a patient-centered care pathway for patients treated with oral anticancer drugs: a multicenter pre-post-test study in Flanders

“…Program drift is a known concept in implementation science, entailing that adaptation of complex interventions and deviation from the protocol at the implementation phase is presumed to decrease the expected effect of an intervention [29,30]. Third, the post-test was set up approximately three to six months after implementation of the care pathway, which is in line with the recommendation in the 7-phase method [9]. However, this time window might have been too short.…”

“…To thoroughly restructure a care process, a care pathway can be developed and implemented (15). A care pathway or clinical pathway is "a complex intervention (or multi-component intervention) for the mutual decisionmaking and organization of care processes for a well-defined group of patients during a well-defined period" [9].…”

The complexities, coordination, culture and capacities that characterise the delivery of oncology services in the common areas of ambulatory settings

“…Formal, semi-structured interviews were undertaken with ‘navigators’, staff members with an overview of care pathways (a model or tool designed to guide optimal care planning, coordination and evidence-based cancer care) [ 39 ]. Interviews were oriented by care pathway maps derived from Fennell et al’s (2010) [ 40 ], mapping of MDC in the patient journey (Fig.…”

Improving routine use of clinical pathway decision support through integration of an EHR with a clinical library resource designed to provide evidence-based guidance within oncology workflows

“…Oncology treatment is complex and rapidly evolving, with a need for timely access to life-changing therapeutics matched to cancer stage and individual genomic considerations [ 1 ]. The use of care pathways in oncology has been shown to improve patient care outcomes [ 2 – 5 ]. Kaiser Permanente (KP) has a foundational mission to provide evidence-based, up-to-date, high quality, equitable care to our members.…”