Robert Daly: Clinical Pathways Need to be Grounded in the Evidence


Journal of Clinical Pathways spoke with Robert Daly, MD, MBA, regarding the role of clinical pathways in the future of health care (September 8-10, 2017; Washington, DC).

My name is Bobby Daly. I’m an assistant attending at Memorial Sloan Kettering. Within the past year, I was also the ASCO health policy fellow.

Which session have you attended that has been the most meaningful for you in your practice?

I really enjoyed the session on lung cancer pathways. It was a discussion around the latest evidence, around treating metastatic non-small cell lung cancer and how to integrate that evidence into pathways. The session really looked at what does “efficacy” mean, what does “cost” mean, what does “toxicity” mean, and putting it all together to create the pathways.

What were your thoughts on the mock pathway session?

I enjoyed it. I thought the discussion was really robust and it showed how complex it can be to develop pathways. There was a lot of really good discussion around the data and it goes to show how oncologists can bring the anecdotal evidence to bear, but really the data from the studies is needed to add guardrails to the discussion to make sure that when a selection is determined, there is real evidence behind it to support that selection.

You saw the personal bias early on, but the finished package in the end was evidence-driven.

Yes. The conversation at many points was veering into individual patient experiences, and I think that is important because often times you will have to go off pathway to accommodate an individual patient’s comorbidities or financial toxicities. But it is really important that the pathways are grounded in the evidence.

How important are clinical pathways in health care moving forward?

I think we’ve really seen pathways gain momentum in value-based care in oncology. It has been exciting to watch as a health policy fellow and to work with the ASCO task force on clinical pathways. Pathways offer an opportunity to standardize care, provide the most cost-effective care when efficacy and toxicity are similar, and truly account for cost. Pathways also allow us to really promote clinical trials. Pathways also provide us with data which can be missing from the EHRS such as stag and molecular subtype, which allows us to better understand our patient population and risk stratify them. Pathways really have been gaining a lot of momentum within oncology care and I can understand why, given what they can contribute.