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Evaluation of the Prostate Cancer Molecular Testing Pathway (PCMTP) Within the Veterans Health Administration (VHA)


 

Purpose

The PCMTP was developed to provide standardized decision support for molecular testing for veterans with prostate cancer.

Background

Prior to the precision medicine era, molecular tumor testing in prostate cancer was not standard of care. Field practitioners were unfamiliar with the role of molecular testing in clinical care. The PCMTP provides direction for germline and tumor testing in appropriate patients with prostate cancer. The expectation is that at least 80% of veterans will be pathway adherent. The PCMTP is an Oncology Clinical Pathway (OCP) that supports evidence-based practice providing highquality, safe, and cost-effective care for veterans reducing variability of care in the VHA.

Methods

The National Oncology Program Office assembled a Prostate Cancer Team (PCT) to develop OCPs. The pathways were incorporated into note templates that record clinical decisions using text and metadata (Health Factors [HF]), and record pathway adherence for the 4 key nodes of the PCMTP. The templates were pilot-tested and improved using an iterative process over a 3-month period. Further evaluation was conducted by the Office of Human Factors Engineering and the National Clinical Template Workgroup, utilizing a heuristic evaluation to ensure standardization, interoperability, and reduce duplication. HF data were retrieved from the Corporate Data Warehouse using a custom-built dashboard. Descriptive statistics of PCMTP use are presented.

Results

Between 4/1/2021 and 6/22/2022, 6276 health factors were generated from 1707 unique veterans in whom this clinical pathway was accessed. 328 distinct providers participated at 61 sites. Average veteran age was 73 years. (range 45-100) including 42% Black and 56% White. Of 1243 veterans considered for germline testing, 96.6% had germline testing ordered and for 1102 veterans considered for tumor testing, 93.3% had tumor testing ordered.

Conclusions

Pathway adherence exceeded the 80% benchmark. Race representation was diverse and reflective of the VA prostate cancer population. About 46% of VA oncology practices have used the PCMTP for ~11% of the estimated 15,000 veterans with metastatic prostate cancer in VHA. Increased use of this pathway is expected to improve outcomes for veterans with prostate cancer

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