Finding the Path: Incorporating Patient Preferences into an Interactive Clinical Pathway Platform (S867)

1.Identify preferences that affect treatment decision-making among women with Stage I-III breast cancer.2.Describe a new clinical pathway model that will incorporate women’s preferences for individualized assessments of prognosis and treatment benefits and challenges, and that will facilitate shared-decision making and use of palliative care services. Clinical pathway tools offer physicians a selection of cost-effective, evidence-based treatment options to discuss with patients. Although shared decision-making is essential to patient-centered care, clinical pathway tools have not integrated patient preferences around treatment burden and outcomes. We sought to identify patient preferences for incorporation into MyPATHway, a patient-centered, interactive clinical pathway platform for patients with breast cancer. Using interpretive description as an approach, we conducted individual qualitative interviews with women aged 18+ treated for Stage I-III breast cancer at Smilow Cancer Hospital in New Haven, CT. We asked participants if there was additional information they would have liked prior to treatment decision-making, their preferences for and factors affecting decision-making, and their attitude towards an electronic platform, including preferences for learning about and weighing treatment burdens and outcomes. We coded transcribed interviews and analyzed them for themes. The sample’s (n=21) mean age was 56.4 (range 29-74). Breakdown of cancer stage was I (33.3%), II (42.9%), and III (23.8%). Participants reported receiving adequate information prior to treatment decision-making, although some wanted more regarding what to expect during and after treatment. Several factors affected treatment decision-making, including physical (e.g., symptom burden), lifestyle (e.g., ability to function in normal roles), provider (e.g., provider opinion), and health care system (e.g., consistency of care) factors. Participants strongly felt they had “final say” in treatment decision-making while preferring involvement of providers and family caregivers. Most were open to using an electronic platform at home or in clinic, but to augment versus to replace face time with providers. Participants identified preferences regarding content and format that build on currently available clinical pathway tools.