Harvard Medical School, Boston, MA
Lisa Rotenstein, Alexander O. Kerman, Neil E. Martin, Tracy A. Balboni, Monica Shalini Krishnan, Joseph Killoran, Allison Taylor
Background: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a clinical pathway tool on appropriate SFRT rates in an academic radiation oncology practice. Methods: Clinical pathways increase compliance with treatment guidelines, improve outcomes, and reduce costs. Guidelines recommend single fraction radiation therapy (SFRT) for palliation of uncomplicated bone metastases, but implementation is variable. We examined the effects of a clinical pathway tool on appropriate SFRT rates in an academic radiation oncology practice. Results: The final pathway was used in 38% of 723 bone metastases radiation prescription made since March 2016, with appropriate SFRT rates rising from 18% prior to implementation to 48% post-launch in cases where the pathway was used (p < 0.01). There was no increase in the appropriate SFRT rate for cases treated after March 2016 but not entered into the pathway tool as compared to cases prior to pathway tool implementation. Major reasons for rejecting recommendations included disagreement with life expectancy prognostication and patient convenience. The pathway increased physicians’ confidence regarding compliance with treatment guidelines and made it easier to find well-supported treatment recommendations. Workflow disruptions and the inability to handle nuanced situations emerged as limitations. Conclusions: Our experience demonstrates the utility of clinical pathway decision support for bone metastases in complex academic settings. Pathway use significantly increased appropriate care, more than doubling appropriate treatment rates relative to a synchronous group. Next steps include increasing the pathway’s ease of use, refining its prognostic abilities, and measuring related value effects.
Disclaimer
This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org
Abstract Disclosures
2016 Palliative and Supportive Care in Oncology Symposium
First Author: Lisa Rotenstein
2018 Palliative and Supportive Care in Oncology Symposium
First Author: Nina Desai
2022 ASCO Quality Care Symposium
First Author: Natalia Simon
2018 ASCO Annual Meeting
First Author: Nina Desai