Table 3 Intervention characteristics of included primary studies

1

Chen et al. 2000 [20]

Historical control group (prepathway, Sep 1993–Dec 1994)

Contemporaneous nonpathway group (Sep 1996-Aug 1998)

Clinical pathway group (Sep 1996-Aug 1998)

Patients underwent the same surgical procedure during the time of implementation, but were not managed based on the pathway. The treated physician decided solely to place patients on the pathway.

The neck dissection pathway was presented in a tabular format and consists of the following aspects: assessment/evaluation, consult, diagnostic test, treatment, medication, performance status/activity, nutrition, teaching/psychosocial, discharge planning, outcome criteria and follow-up criteria. The activities were described for the initial evaluation, preoperative visit, and same day admit surgery.

Meets criteria 1–4

Length of hospital stay (median)

Complications

Readmission

Costs of care

2

Dahl et al. 2017 [25]

Before implementation (Sep 2004–Aug 2005)

After implementation total (May–Aug 2010)

After implementation pathway referred (May–Aug 2010)

After implementation non-pathway referred (May–Aug 2010)

The framework of the Danish cancer pathways includes three different descriptions of the pathway: a flowchart, a narrative text and a table providing an organizational overview. A pathway in the Danish context is a standardized pathway that most patients suspected of cancer will be able to follow. It describes the patient’s pathway from clinical suspicion of a certain cancer through diagnostic procedures and treatment. The pathway describes the medical procedures, the necessary organization encompassing both primary and secondary sectors of the health system, and timeframes in accordance with the political agreement. Main emphasis in the pathways are on information to be given to the patient, explicit identification of the responsible health professional or department in all phases, procedures for referral, description of multidisciplinary teams in each pathway as a forum for decisions on diagnosis and recommended treatment, and timeframes of all phases. An example of a pathway is shown [Probst et al. 2012].

Meets criteria 1–4

Patient dissatisfaction with long term waiting times

3

Gendron et al. 2002 [21]

Control group (pre-pathway) (1995)

1 year after pathway implementation (July 1996–July 1997)

3 years after pathway implementation (1999)

The pathway for patients undergoing major resection for upper aerodigestive tract cancer was implemented in July 1996. The format for the pathway is a 1-page table containing a list of goals and interventions for each postoperative day, followed by a page for each day on which accomplishments are recorded. When goals were not met, the variances are recorded in detail on the flow sheet.

Meets criteria 1–4

Length of stay (median, range)

Readmission

Complication rates

Hospital charges

4

Ghosh et al. 2001 [22]

Separate groups for cervical and endometrial cancer:

Preintervention group (Jan 1997–June 1998)

Postintervention group (July 1998–Dec 1998)

Postintervention group (Jan 1999–June 1999)

Postintervention group (July 1999–Dec 1999)

Care pathways for patients with gynecologic malignancies were developed based on the results of clinical trials and on the consensus of experts. The pain control team and a pharmacist were involved. The nursing team played an active role in the practicality of the execution of these care plans. Documentation including preprinted orders were created and approved by hospital committees. Postoperatively, patients were placed on preprinted orders, which addressed patient education, rapid diet advancement, a reduction in laboratory tests, deep vein thrombosis prophylaxis, and pain management.

Meets criteria 1–4

Length of hospital stay (mean, SD)

Total costs

Direct costs

Patient satisfaction

Readmission rates

5

Jeong et al. 2011 [23]

Separate groups for early gastric cancer and advanced gastric cancer:

Non care pathway (general care) group

Pathway group

Both groups: Dec 2006-Nov 2007

The pathway was first implemented in September 2004. The pathway for patients with gastric cancer following gastrectomy were developed in 2006 to provide care for these patients. The pathway was electric medical record based. In the pathway for hospital staff which is presented in figure 1, the aspects: Lab, Treat, Activity, Diet, Mx, Education, and Evaluation were described for the day before surgery, the day of surgery until 2/3 days after surgery (preoperative laboratory tests and diagnostic modalities, assessment of concomitant diseases, consultation for operative safety, bowel preparation and antibiotics at preoperative day 1 and postoperative day 1, removal of nasogastric tube, start of semi-fluid diet, removal of closed suction drain before discharge. There is also a pathway for patients; this is presented in Fig. 2.

Meets criteria 1–4

Length of hospital stay (pre, post and total) (mean)

Costs (pre, post and total)

6

Kiyama et al. 2003 [18]

Traditional care group (control)

Clinical pathway group

Both groups: January 2001 to December 2001.

The CP employed standardised postoperative management using printed order sets, which included instructions for such matters as medication, diet, removal of the catheter and the mobility of the patients.

Meets criteria 1–4

Length of hospital stay: pre- and postoperative (mean, SD)

Morbidity rate

Postoperative complications

7

Tastan et al. 2012 [24]

Control group (clinical pathway was not used)

Clinical pathway group

Both groups: March 2004-April 2005

The clinical pathway was constructed after conducting a literature survey. The clinical pathways were organized to make them suitable for the clinic by considering work order and resources of the clinic along with the doctors and nurses. For this study, a standard clinical pathway that included possible problems of the patient, clinical goals, and the medical team’s interventions for reaching the treatment goals was designed. Primary components of the breast surgery care protocol are: consultation/visit (physician, anesthetist, and nurse), diagnostic processes, patient evaluation/diagnosis processes, medication, treatment and clinical procedures, diet, activity/security, and psychological/educational/discharge planning (Appendix 1). This was described for the admission day, the operation day and the postoperative days 1 until 4.

Meets criteria 1 - 4

Patient anxiety

Quality of life

Patient satisfaction

8

Williams et al. 2015 [19]

Usual care group

Intervention group

Both groups: Feb 2011-Jan 2013

The usual care treatment is based on the Royal Marsden Hospital Pain and Palliative Care treatment guidelines.

The intervention group received combined screening, treatment and educational approach.

Patients in the usual care group were not proactively assessed at baseline, nor did they receive a timetabled weekly pain assessment conducted by their pain physician They also did not receive the pain education brochure.

Pain assessment and treatment was conducted by two pain clinic doctors and two nurses who were independent of the research team. Treatment took place immediately after allocation to the intervention group, and continued throughout the three month study period. Treatment was individualized according to analgesic needs and requirements according to the Royal Marsden Hospital Palliative Care & Pain Control guidelines, which are based on the WHO and British Pain Society guidelines. First the initial consultation took place. Further, follow-up sessions took place weekly either by telephone or in a pain clinic consultation. Each patient was also given an educational brochure about cancer pain and its treatment and this was discussed with a control pain doctor at the baseline time point. Subjects were asked proactively about their suitability for these additional pain control treatments. Different analgesic drugs and their expected benefit and side-effects were discussed.

Meets criteria 1–4