Introduction: Upper gastrointestinal cancers are a significant health problem, with low survival, high symptom burden and unmet supportive care needs. Evidence-based clinical care pathways to standardise symptom management could provide a means to reduce symptom burden and improve quality of life in these patients.
Method: A standardised model for clinical pathway development was used, this included: 1) assembling a team of experts; 2) compiling and reviewing existing literature; and 3) developing the pathway via a consensus working group process. A Clinical Working Group (CWG) was convened and included representatives of relevant specialities with established expertise and clinical experience from across ten public, private, metropolitan and regional health services in Victoria, Australia. Literature reviews were conducted to identify existing clinical symptom management and triage pathways or guidelines for patients with cancer as well as to identify any validated disease-specific patient-reported outcome measures in order to ascertain potential symptoms. The initial pathways were drafted by cancer nurse consultants with over 10-years clinical experience in consultation with a ‘clinical champion’. The CWG held workshops to discuss and review each of the draft pathways. The pathways were updated and circulated to the whole CWG via email for final approval.
Results: A total of 64 disease-specific symptoms were identified. The CWG finalised and approved 19 clinical pathways to manage these symptoms. Each clinical pathway includes an informed tailored clinical assessment of the symptom based on the NOPQRSTUV Symptom Assessment Acronym, triage of the symptom using the Common Terminology Criteria for Adverse Events (Version 5.0) and interventions for appropriate follow-up care.
Conclusion: A multidisciplinary approach and clinical consensus informed the development of evidence-based clinical pathways, which provide a standardised platform to appropriately manage and triage symptoms reported by people with upper gastrointestinal cancer.