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A recent survey conducted by CancerCare of more than 1,300 breast, colon, lung and prostate cancer patients diagnosed within the past five years found that the vast majority had not heard the term “clinical pathway”. Even after it was defined, fewer than half claimed to be familiar with the term.

Clinical pathways are multidisciplinary care plans that provide specific guidance on the sequencing of care steps and interventions. In oncology, pathways are widely used to guide treatment decisions and payers increasingly provide financial incentives to oncologists who agree to treat patients based on them.

Patients trust their physicians. In fact, 97% of survey respondents considered their physicians recommendations to be very or somewhat important in helping them decide on a treatment plan. However, growing use of pathways raises questions about the tools on which physicians are basing their recommendations. Recent research has found that there is little accountability for pathway developers to ensure that these tools follow guidelines and evidence-based care.ⁱ

It’s hard to avoid the conclusion that more work is needed to promote shared-decision making in oncology. Nearly all respondents indicated that if their doctor based a treatment plan recommendation on a pathway, they would have important information needs.

1. What the scientific and medical evidence is that supports using it
2. Who wrote or developed the pathway
3. What the out-of-pocket costs will be for me
4. Whether it will prevent me from getting other treatments later
5. If my doctor is receiving any kind of reward or benefit for using it to treat me
6. What are other treatment options and how do they differ from the clinical pathway
7. How many patients have been treated on this pathway and what their outcomes are

According to these findings there is a critical need for significant information flow from providers to patients regarding the basis for and impact of treatment recommendations. Physicians who treat people with cancer should recognize that providing information is a fundamental part of patient-centric care. Deciding on a treatment plan should be a collaborative process that considers an individual patient’s characteristics, needs, and treatment goals. When presenting treatment options, care team members should fully explain the rationale, implications, costs, and benefits in the spirit of partnering with patients to deliver optimal care. When providers are using clinical pathways or similar tools to guide treatment decisions, patients must be part of the conversation.

ⁱAvalere Health, LLC. Clinical Pathways: Overview of Current Practices and Potential Implications for Patients, Payers, and Providers. July 2015 http://avalere-health-production.s3.amazonaws.com/uploads/pdfs/1438002728AHPathways_final.pdf