Providing Guideline-Based Oncological Care in CCCNs Through Implementation of Tumour-Specific Patient Pathways Using the iPA2-Guide

Key Contextual Factors

The following definition of patient pathways was developed and agreed upon: “A patient pathway is an evidence-based tool that supports the planning and management of the care process of individual patients within a group of similar patients with complex, long-term conditions. It details the phases of care, guiding the whole journey a patient takes by defining goals and milestones, and supports mutual decision-making by the patient and his/her multidisciplinary care team collaborating in a comprehensive network of care providers.” (Richter, Hickmann, Schlieter 2021). The work on patient pathways further comprises the following:

• A methodological guide (documented with the iPa2-Guide) for the creation and implementation of tumour-specific patient pathways in CCCNs was developed and agreed. 
• By applying the iPa2-Guide, pancreatic and colorectal patient pathway templates for CCCNs were developed and agreed. For both entities, the iPAAC quality indicator sets for the certification of CCCNs are represented in the patient pathways.

Key Components/Steps

• The patient pathway templates developed were implemented at the Lower Silesian Oncology Center (LSOC) in Poland and at the Charité Berlin in Germany. Therefore, they were adapted to the national, regional and local conditions. The degree of implementation can vary significantly, depending on the CCCN's commitment regarding organisation and technical implementation of patient pathways, digitalisation or data collection for pathway monitoring processes. In cases of the pilots, the degree of implementation ranged from the integration of the templates into the CCCN's document management system to fine granular adaptation of the pathway process according to national, regional and local conditions. Patient pathway development and the adaptation of patient pathway templates to individual conditions of a CCCN are complex iterative processes which need sufficient framing as given with the iPa2-Guide.

Main Impacts / Added Value

The added value of the iPa2-Guide is intended to be in the structuring and harmonisation of patient pathway development and implementation. A preliminary study among WP10 members on the expected impact of the template-based patient pathway development gives first insights into added value expected. It concerns the following aspects:

• Improving the quality of care in CCCNs.
• Creating a uniformly high level of quality care.
• Shortening the development time for patient pathways in CCCNs.
• Simplifying the development of patient pathways in CCCNs.
• Improving evidence-based practice.
• Increasing reusability of patient pathways.
• Increasing the quality of patient pathways implemented in CCCNs.
• Contributing to internal dissemination of relevant knowledge.
• Increasing comprehension of the patient pathway care process.

Added value of practical patient pathway usage and the use of templates needs further evaluation.

Lessons Learned

• The iPa2-Guide provides a common understanding, structure and uniform process for the patient pathway development team. This helps to organise the pathway development in a multi-professional, interdisciplinary team.
• The commitment of the patient pathway development team within the CCCN is crucial for successful patient pathway development.
• Digital application support for template adaptation and patient pathway modelling is highly appreciated by the pathway development team. A unified tooling allowing for digital development, export and exchange of patient pathway templates and their individual adaptation is highly recommended – as is a centralised patient pathway template repository for CCCNs.

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