Development of Health Pathways to Standardize Cancer Care Pathways Informed by Patient-Reported Outcomes and Clinical Practice Guidelines

Abstract

Purpose High-quality symptom management and supportive care are essential components of comprehensive cancer care. We aimed to describe the development of an evidence-based automated decisional algorithm for patients with cancer that had specific, actionable, clinical, evidence-based recommendations to improve patient care, communication, and management. Methods We reviewed existing literature and clinical practice guidelines to identify priority domains of patient care and potential clinical recommendations. Two multidisciplinary clinical advisory groups used a two-stage consensus decision-making approach to determine domains of care and patient-reported outcome (PRO) measures and subsequently developed automated algorithms with clear clinical recommendations amendable to intervention in clinical settings. Results Algorithms were developed to inform management of patient symptoms, distress, and unmet needs. Three PRO measures were chosen: Distress Thermometer and problem checklist, Edmonton Symptom Assessment Scale, and the Supportive Care Needs Survey–Screening Tool 9. PRO items were mapped to five domains of patient well-being: physical, emotional, practical, social and family, and maintenance of well-being. A total of 15 actionable clinical recommendations tailored to specific issues of concern were established. Conclusion Using automated algorithms and clinical recommendations provides a platform for streamlining and systematizing the use of PROs to inform risk-stratified guideline-informed care. The series of algorithms, which set out systematized care pathways for the clinical care of patients with cancer, can be used to potentially inform patient-centered care.

What are the attitudes of health professionals regarding patient reported outcome measures (PROMs) in oncology practice? A mixed-method synthesis of the qualitative evidence

“…8 Prince of Wales Clinical School, University of New South Wales, Sydney, NSW 2052, Australia. 9 Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA 5000, Australia. 10 College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia.…”

“…A systematic review found that PROMs may be useful in cancer care, to longitudinally monitor and respond to the impacts of treatments or symptoms on patients' lives [8]. For example, some PROMs are designed to automatically trigger the provision of tailored information to patients to help them address their symptoms and side-effects [4,9,10].…”

Cancer survivorship care during COVID-19—perspectives and recommendations from the MASCC survivorship study group

“…Although a range of tools are available (e.g., the DT), such tools are not routinely implemented in survivorship settings. Screening for survivors' needs and the prioritization of care often requires a highly contextualized approach consistent with the local setting and resources [5]. Implementation of a standardized method to screen for, and manage, the immediate needs of cancer patients at each cancer center is likely helpful for future management of crisis and pandemic situations.…”

From Patient Engagement to Precision Oncology: Leveraging Informatics to Advance Cancer Care

“…While there is a wide range of PROs that could be assessed during cancer treatment and in survivorship, several efforts have aimed to identify key domains relevant to improving outcomes in cancer care. For example, a clinical advisory group identified priority domains and measures to enhance cancer care, which included distress and symptoms [12][13][14] and unmet needs [15]. Girgis et al, then developed clinical recommendations from these domains, mapped them into well-being categories, and demonstrated that these recommendations could algorithmically provide automated clinical feedback [15].…”

“…For example, a clinical advisory group identified priority domains and measures to enhance cancer care, which included distress and symptoms [12][13][14] and unmet needs [15]. Girgis et al, then developed clinical recommendations from these domains, mapped them into well-being categories, and demonstrated that these recommendations could algorithmically provide automated clinical feedback [15]. There is also concern that the use of structured questionnaires to assess PROs may limit the ability to capture the broad range of symptoms experienced by patients during treatment.…”