Abstract P4-04-10: Improving early breast cancer care coordination - Digital care pathway: Implementation and Pivotal Results

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Abstract Introduction: Care coordination has no consensus definition. A systematic review (McDonald KM.) purposed a broad definition: "Care coordination is the deliberate organization of patient care activities between two or more participants (including the patient) involved in a patient's care to facilitate the appropriate delivery of health care services. Organizing care involves the marshalling of personnel and other resources needed to carry out all required patient care activities and is often managed by the exchange of information among participants responsible for different aspects of care." In 2007, Vanhaecht et al. defined the term ‘care pathway’ or ‘pathway’ as follows as “A care pathway is a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period. The aim of a care pathway is to enhance the quality of care across the continuum by improving risk-adjusted patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources.” Methods: In 2023 a non-fixed time but phase-oriented Early Breast Cancer Care Pathway was developed in the Breast Cancer Clinic of a University Hospital. In the first phase, interviews with breast cancer experts (medical oncologist, breast cancer surgeons, nurses, pathologist) were performed. The model was developed and the experts were requested to validate the pathway. The second phase, was testing the developed model and characterized patients (pts) included prospectively in the first 6 months, 26thOct 2023 to 30th April 2024. Time to treatment initiation (TTI) was defined as days (d) from diagnosis (using the most recent tumor board as a surrogate for diagnosis) to first treatment (surgery or systemic therapy). Results: During 2023, using UpHill's® software it was possible to provide seamless patient journeys with automation and patient communication. Professionals can access a shared history of all actions executed for each patient as well as the expected next steps permitting a fast recognition of patient current status and forecast future needs. Go live was 26th October 2023. Here we report the first 6 months experience. The digital pathway permits real time data collection in an automatic way. 593 pts entered the pathway with a breast cancer sign/symptom warranting further investigation, of these 162 were discussed at least once in a tumor board. In 62 pts a surgery was performed and 27 pts started treatment at the Oncology Day Care Unit. In predefined key points UpHill's® software interprets the information sent by pts to automate decisions (post-surgery and post medical oncology day care session). Median TTI was 32d, 14d and 34d for medical treatment and surgery, respectively. There were 88 automatic generated interactions that resulted in 62 pts responses (70,5% response rate, rr ); post-surgery 55 automatic generated interactions that resulted in 35 responses (63,6% rr); post medical oncology day care session 16 automatic generated interactions that resulted in 14 responses (87,5% rr). Conclusion: There is the need to ensure Health systems to simplify access and reduce operational barriers to initiating treatment. Studies of interventions to simplify access, ease navigation and reduce barriers are warranted to diminish the potential harm to pts. Real time automatic data collection has the advantage to provide high quality data with minimal human effort. Automate actions eliminates repetitive tasks permitting focus on actions that truly depend on human reasoning. Clinical pathways are one of the main methodologies to organize and coordinate care processes but the methodology needs to be further improved. It is a complex intervention and our model needs to be developed and continuously followed up. Citation Format: Sónia Oliveira, Leonor Fernandes, Diana Simão, Carlos Vitorino, Susana Nunes, Clara Sampaio, Joana Raposo, Helena Xavier, Sara Pires, Clara Jasmins, Ana Andrade, Manuela Martins. Improving early breast cancer care coordination - Digital care pathway: Implementation and Pivotal Results [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2024; 2024 Dec 10-13; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(12 Suppl):Abstract nr P4-04-10.

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