A Greater Focus on the Patient

One of the core goals of clinical pathways development has always been to make health care more patient-centered. However, a common complaint regarding clinical pathway development is that patients are often left out of the process. The importance of incorporating the patient perspective in health care decision-making is highlighted in several articles in this issue of Journal of Clinical Pathways.

Patient-reported outcomes are essential for evaluating the overall impact of health care interventions on patients’ wellbeing. This is especially true as health care delivery continues to develop a greater focus on value and the quality of care. In a series of Viewpoints, authors discuss the current and future challenges of incorporating patient-reported outcome measurement in research and clinical practice (page 37).

Overly aggressive end-of-life (EOL) care may not be consistent with patient wishes or associated with better health. Several studies indicate that patients with cancer who have co-occurring depression are less likely to adhere to treatments and more likely to have other comorbidities and prolonged hospital stays, factors can lead to more aggressive EOL cancer care. Kathy Doan, MPH, and colleagues investigated whether depression is associated with differences in EOL care intensity in a population-based cohort of Medicare beneficiaries who died from cancer (page 47). The authors suggest that patient preferences play a role in EOL care patterns, such that patients with cancer and depression may adopt nihilistic attitudes toward their illness or prefer a quality-enhancing approach that incorporates palliative care options. Improved protocols for appropriate mental health treatment for patients with cancer can promote better, more empathetic care that aligns with patient preferences. 

While cancer screening is essential for detecting disease in the earliest stages, these tests can be physically invasive, costly, and cause unnecessary stress and worry to patients. For these reasons, a number of organizations have developed guidelines that are intended to optimize screening strategies in order to spare all but the most at-risk patients from undergoing screening. However, as Jeremy Schafer, PharmD, MBA, points out, determining the value of screening is a difficult task. Focusing specifically on the Preventive Services Task Force (USPSTF) recommendation that prostate-specific antigen (PSA) levels no longer be used as a means of screening for prostate cancer, Dr Schafer discusses the potential negative implications of declining PSA testing and argues that a more patient-focused, rather than population-based, screening strategy be used to improve the value of PSA screening (page 33).

As these articles show, a greater focus on the patient can improve the patient experience of care, the effectiveness of care delivery, and the evaluation of care outcomes.