Segment 9: Ease of Integrating Pathways Based on Site of Care

According to Blase Polite, MD, MPP, it is much harder for a cancer center to adapt care pathways than it is for a smaller clinic because the physicians at academic medical centers are all experts in their fields and they have strong opinions.

By definition there is some wiggle room when it comes to things like efficacy, toxicity, and costs of a pathway, but it it’s another matter to define those without consensus, he said. Some medical centers, in order to approach this issue, have allowed their experts some flexibility and input when it comes to tweaking the pathways. “You still require that we’re going to do something a priori,” Dr Polite continued. “We’re going to treat patients and we’re going to measure that. Now, over time I think we will drive to consensus opinion…”

The point is that you cannot merely tell a person how things will be done, Dr Polite elaborated. They have a harder time when the order comes from above and they have not been consulted. Physicians should be put on committees because once they have had the opportunity to debate it and understand how consensus was achieved, it is okay. “I think it’s about having a process, again, like Kathy’s Via Oncology, where people can be at a table and express their opinions of why they think things should be done differently,” Dr Polite stated.

Michael Fisch, MD, MPH, concurred on Dr Polite’s evaluation of the challenge in adapting pathways to cancer centers, but added that there is another process going on, as well. Academic centers, he said, are beginning to “figure out and focus on other ways that they distinguish themselves from the competition in the community other than sort of the guru-based standard treatment choices.”

In addition to continuing access to clinical trials and unique therapies, academic cancer centers will emphasize their expertise in pathology and surgery, while learning to compete in patient-centered care and communication, Dr Fisch said. He also expects academic centers to look at how “other kinds of resources are put together so that the outcomes that are achieved in the academic setting or in any setting is the basis of competition.”