CHICAGO – The US Department of Veterans Affairs (VA) has developed clinical pathways to guide its clinicians through cancer care, but they should not be considered mandatory strategies, a top VA cancer director told colleagues at the 2023 annual meeting of the Association of VA Hematology/Oncology.
“They’re not a cookbook for how to practice oncology,” said Michael Kelley, MD, the VA National Program Director for Oncology, Professor of Medicine at Duke University, and Chief of Hematology and Oncology at the Durham VA Medical Center. “You cannot look at the pathway and think that you know how to practice. It is a preferred-decision flow map—not a requirement to do that. We expect that all providers will be off the pathways some of the time and most of the time, they will be on there.”
The VA has an extensive series of clinical pathways in oncology that are designed to help clinicians navigate through the treatment of 20 types of cancer, including common types—breast, lung, and colon—and rarer types, such as salivary gland and biliary tract cancer. Many of the pathways have been updated within just the past few months, and more are in the works.
The pathways are developed through subject-matter expert groups made up of experts from National Cancer Institute–designated cancer centers, Kelley said. “The pathway is published as a PDF document on internally and externally facing websites, then it's built into the medical record system.” Clinicians who diverge from the pathways have to note this in the health record system, enter reasons why, and provide the alternative care strategy, Kelley explained.
Moving forward, the VA is “committed to doing a formal review of all the pathways at least quarterly, and we will do ad hoc reviews and alterations as information merits.” He said, “There are hundreds of oncology providers in the VA, and we want everyone to have an opportunity to have input. That's your opportunity: We do read every comment, and we'll actually generate a response to every comment.”