Effects of oncological care pathways in primary and secondary care on patient, professional and health systems outcomes: a systematic review and meta-analysis

Systematic Reviews

Michelle Fiander¹  Jolanda C. van Hoeve²  Sabine Siesling²  Robin W. M. Vernooij³  Thomas Rotter⁴  Peter Nieboer⁵ 

[1] College of Pharmacy, Department of Pharmacology, University of Utah, Salt Lake City, USA;Department Health Technology & Services Research, University of Twente, Enschede, the Netherlands;Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands;Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands;School of Nursing, Queen’s University, Kingston, Canada;Wilhelmina Hospital, Assen, the Netherlands;

关键词: Care pathways;    Clinical pathways;    Integrated care pathways;    Care maps;    Oncology;    Cancer;    Systematic review;   

DOI  :  10.1186/s13643-020-01498-0

来源: Springer

【 摘 要 】

BackgroundPathways are frequently used to improve care for cancer patients. However, there is little evidence about the effects of pathways used in oncological care. Therefore, we performed a systematic review and meta-analysis aiming to identify and synthesize existing literature on the effects of pathways in oncological care.MethodsAll patients diagnosed with cancer in primary and secondary/tertiary care whose treatment can be characterized as the strategy “care pathways” are included in this review. A systematic search in seven databases was conducted to gather evidence. Studies were screened by two independent reviewers. Study outcomes regarding patients, professionals, and system level were extracted from each study.ResultsOut of 13,847 search results, we selected 158 articles eligible for full text assessment. One hundred fifty studies were excluded and the remaining eight studies represented 4786 patients. Most studies were conducted in secondary/tertiary care. Length of stay (LOS) was the most common used indicator, and was reported in five studies. Meta-analysis based on subgroups showed an overall shorter LOS regarding gastric cancer (weighted mean difference (WMD)): − 2.75, CI: − 4.67 to − 0.83) and gynecological cancer (WMD: − 1.58, CI: − 2.10 to − 1.05). Costs were reported in six studies and most studies reported lower costs for pathway groups.ConclusionsDespite the differences between the included studies, we were able to present an evidence base for cancer care pathways performed in secondary/tertiary care regarding the positive effects of LOS in favor of cancer care pathways.Systematic review registrationPROSPERO CRD42017057592.

【 授权许可】

CC BY