ABSTRACT
BACKGROUND: Management of
rectal cancer has become more complex with multimodality
therapy (
neoadjuvant chemoradiotherapy and
surgery ) and this has led to the need to organize multidisciplinary teams. The aim of this study was to
report on the
planning , implementation and evaluation of an integrated care pathway for
neoadjuvant treatment of middle and lower
rectal cancer . DESIGN AND
SETTING: This was a cross-sectional post-implementation study that was carried out at a public
university cancer center.
METHODS: The Framework for
Program Evaluation in
Public Health of the
Centers for Disease Control and Prevention (
CDC ) was used to identify
resources and activities; link results from activities and outcomes with expected
goals ; and originate
indicators and outcome measurements.
RESULTS: The
logic model identified four activities stakeholders' engagement,
clinical pathway development,
information technology improvements and
training programs ; and three categories of
outcomes: access to care ,
effectiveness and organizational outcomes. The measurements involved 218
patients , among whom 66.3% had their first
consultation within 15 days after admission; 75.2% underwent
surgery < 14 weeks after the end of
neoadjuvant treatment and 72.7% completed the
treatment in < 189 days. There was 100% adherence to the protocol for the regimen of
5-fluorouracil and
leucovorin .
CONCLUSIONS: The
logic model was useful for evaluating the implementation of the integrated
care pathways and for identifying measurements to be made in
future outcome studies .