Breast Cancer Pathways Impact on Shared Decision Making and Patient Experience in Academic and Community Practice
Pathways have been implemented in oncology primarily in the effort to reduce variability and cost of care. However, the use of these decision support tools in a manner transparent with patients has the potential to transform patient education and counseling. This may improve patient experience, burden of decision making and quality of life. This project aims to evaluate the impact of chemotherapy education and counseling in breast cancer using pathway-based education and counseling tools. Patients will be informed of the use of pathways, and the reasons for variation from pathway where it occurs. This will be studied in a tertiary referral center and a group of community oncology practices serving diverse urban, suburban and rural populations. This study will occur coincident with implementation of a point-of-care pathway program integrated with the electronic health record in these practices. This will allow for pre-implementation control and post-implementation test groups. The impact of the pathway-based counseling will be assessed using qualitative surveys and quantitative instruments assessing the burden of decision making, decision regret, patient distress and quality of life. Provider acceptance and work flow impact will also be assessed. The findings of this study can be extended to any oncology practice using clinical pathways in breast cancer and to other cancer types.
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