Derivation of clinical pathways using evidence-based clinical practice guidelines, illustrated by female breast cancer treatment

Introduction: The use of evidence-based Clinical Practice Guidelines may contribute to the assurance and enhancement of medical services. A practice oriented realisation within a process- and reference-model supports its implementation and acceptance through reduction of implementation-costs. This article aims at developing a method that allows the derivation of a clinical pathway by using a practical-oriented reference model which is based upon a Clinical Practice Guideline. Methods: For the methodological development both concepts – Clinical Practice Guideline and clinical pathway – will be contrasted on a normative-analytical level. This helps finding out similarities and differences of the concepts. Secondly we develop a suitable procedure for deducting a clinical pathway from a Clinical Practice Guideline. The clinical pathways of “Uni-Brustzentrum Essen” and the evidence-based guidelines for breast cancer (“Diagnostik, Therapie und Nachsorge des Mammakarzinoms der Frau”) have been used additionally. Results: The results of the normative-analytical comparison show that – even when the concepts differ in some way – the Clinical Practice Guideline may define general conditions which can be specified by a clinical pathway. The procedure of derivation divides itself into three categories with each two special phases: Derivation of an evidence-based reference model, adaptation to the individual organisation and thirdly implementation of the evidence-based clinical pathway. This method is exemplified by a guideline dealing with breast cancer. Diskussion/Conclusion: A publication of evidence-based Clinical Practice Guidelines as evidence-based reference models would be a support for the transfer from scientific study to practical work. This could contribute to a more frequent use of evidence-based guidelines. The restriction of physician´s decisions and treatments – as a negative effect – is finally contrasted by positive effects like transparency and general comparability of medical services.