Optimal Care Pathways: Clinician Perspective

A/Prof Paul Cashin

There are very few times in medicine, despite the dedication we all have to treating our patients, when we are presented with the opportunity to genuinely make a difference. The development of optimal care pathways (OCPs) has proved to be one of these. The considerable geographical distances between patients and their major tertiary care centres are coupled to an increased patient expectation of personalised care, meaning Australia has a unique health care service to deliver. Many of us practicing in the ‘cancer world’ have for years noticed the disparity in care we are able to provide for our regional patients. We also have a problem organising effective delivery of care in our larger cities. But was this perception of inadequacy real, or were we just remembering the outliers in timeliness of care?

Our impressions were right. Pilot studies looking at cancer care delivery were commissioned in prostate and lung cancer, and subsequently in oesophageal and gastric cancer.

These studies clearly showed that we weren’t in all cases delivering high quality, timely care to patients. We were letting our population down. I never want to see a patient again who has waited months to receive treatment for their cancer!

My record was a three months’ wait to care! Individual tumour summits were developed to tap into all the resources available to help solve these issues. Working parties and design groups were developed around multidisciplinary teams, involving all stakeholders in cancer care provision for individual tumour streams, to develop agreed OCPs. Once this exciting design phase was completed, projects to effect and measure change were commenced. More cancer groups were included and momentum accelerated. Changes were realistic, and most importantly involved our regional colleagues with their unique perspective. This program is, somewhat surprisingly to a political cynic, fully supported by government in terms of funding and resources. It does, however, require huge commitment from individual hospitals and their teams of medical, nursing, allied health and administration staff to enact these programs. It requires commitment from our care deliverers.

For teams who are moving from the design and implementation stage to the outcome measurement phase, it is exciting to see what the effects of these changes will be. For tumour streams who are working toward this, there is a body of experience now available to assist their plans. What an exciting time it is to be involved in real change! From identifying and measuring the problem, convening a tumour summit to discuss the problem and then effecting change, this is how it is meant to work! It has.

To the teams developing these OCP programs, my hat goes off to you. You are genuinely making a difference. Tumour summits continue to be the key in helping monitor change and develop new programs. These are incredibly important! Our patients thank you!