ONS Connections: Comprehensive oncology pathways improve patient outcomes
Programs of comprehensive oncology pathways support several nursing goals. Physician orders have clarity and are standardized, and the treatment options that are prioritized are those that improve efficacy and reduce toxicities. The standardization that comes with oncology pathways provides better opportunities to teach patients consistently and to manage side effects.
Oncology pathways have the purpose of improving the value of cancer care, which is defined as outcomes plus quality divided by cost. Pathways drive not only evidence-based care, but also prioritize options with proven efficacy data. When superiority data is lacking, options are prioritized that have reduced toxicities or costs. The unsustainable escalation of costs and the increasing complexity of treating and managing cancer patients in this time of personalized medicine have led to the need for such solutions as oncology pathways.
The Via Oncology Pathways have been in place at the University of Pittsburgh Medical Center for over six years. Over that time, the pathways have reduced the rate of cost growth when compared with practices not using the pathways. A decision support tool at the point of care is used by oncologists, mid-level practitioners, and oncology nurses. The tool is patient-specific and web-based, and it yields measurable performance metrics by physician, practice, and disease. The content of the tool is developed and maintained each quarter. The hierarchy for the tool is efficacy, toxicity, and, if all else is comparable, cost to the patient and payer.
Hospitalizations have been reduced through this pathways project, and medical error rates have been reduced as regimen selection is streamlined. Adopting oncology pathways has the potential to improve standardization of patient teaching and symptom management, along with reducing medical errors.