Integrating the Patient Voice Into Oncology Clinical Pathway Development

Key Takeaways: 

• At Clinical Pathways Congress (CPC) 2026, panelists emphasized the importance of incorporating patient preferences, socioeconomic circumstances, and logistical barriers into oncology clinical pathway development.
• Patient navigation, shared decision-making, and standardized assessments of social needs were identified as important strategies for improving access to care and aligning treatment decisions with individual patient priorities.
• Panelists highlighted opportunities to use real-world data and artificial intelligence (AI) to integrate clinical evidence with patient experiences, potentially supporting more personalized oncology pathways.

Oncology clinical pathways must account for more than clinical efficacy and treatment costs to support patient-centered care, according to panelists at CPC 2026. During the session, Elevating the Patient Voice in Pathway Development, speakers discussed strategies for incorporating patient preferences, socioeconomic barriers, and real-world experiences into pathway development and treatment decisions.

The discussion featured Alan Balch, PhD, executive chairman of the Patient Advocate Foundation Board of Directors; Rebecca Miksad, MD, MPH, chief medical officer of Color Health; and Susan Sabo-Wagner, MSN, RN, OCN, NEA-BC, vice president of clinical innovation at American Oncology Network (AON).

Advancing Patient Navigation and Shared Decision-Making

Panelists highlighted recent progress in recognizing patient navigation and supportive care as essential components of oncology treatment.

Dr Balch identified palliative care as an established example of a patient-centered model that prioritizes quality of life alongside disease-directed treatment. He also emphasized the growing recognition of navigation services that address socioeconomic and geographic barriers.

Sabo-Wagner discussed AON's efforts to implement principal illness navigation across its network, noting that navigation responsibilities have historically been performed by nurses, medical assistants, and other clinical staff without formal recognition or reimbursement.

She also highlighted the network's use of the Area Deprivation Index to better understand socioeconomic disadvantage among the communities it serves.

Across AON's 21-state network, these assessments help identify potential barriers related to transportation, food insecurity, and access to local resources.

Additionally, Sabo-Wagner noted that 3 AON practices have achieved ASCO Certified status, which emphasizes patient engagement, shared decision-making, and documentation.

Dr Miksad described similar efforts at Color Health, including exploring how patient-centered oncology standards can be incorporated into virtual care delivery.

Addressing Financial Hardship and Social Barriers

A central theme of the discussion was the importance of understanding patients' financial and logistical circumstances before selecting treatment.

Dr Balch emphasized that terminology can influence whether patients feel comfortable discussing sensitive concerns.

He described Patient Advocate Foundation research indicating that patients preferred language such as "financial hardship" over "financial toxicity," suggesting that patient-facing communication should prioritize terminology that reduces stigma and builds trust.

The panelists also discussed how financial hardship, transportation limitations, caregiver responsibilities, and employment disruptions can affect patients' ability to follow recommended treatment plans.

Sabo-Wagner noted that identifying these barriers requires meaningful conversations rather than relying exclusively on standardized questionnaires.

She explained that AON maintains a centralized repository of community resources and evaluates local support services when incorporating new practices into its network.

When gaps are identified, the organization may invest in additional resources to address patient needs.

Dr Balch emphasized that navigation services should not only respond to existing hardship but also identify potential problems before they interfere with treatment.

Balancing Standardization With Individualized Care

The panelists discussed the challenge of reducing unwarranted treatment variation through clinical pathways while preserving flexibility for individual patient circumstances.

Sabo-Wagner explained that patients with similar disease characteristics may experience different outcomes because of socioeconomic conditions, access barriers, and personal priorities.

For example, a treatment regimen requiring frequent visits may be difficult for patients without reliable transportation, child care, or financial resources.

The panelists emphasized that these considerations should be incorporated into treatment planning rather than addressed only after a patient encounters difficulties.

Dr Miksad illustrated the importance of individualized decision-making through an example involving a patient with breast cancer who participated in triathlons.

Understanding the patient's desire to continue swimming helped inform discussions about surgical treatment and preserving shoulder mobility.

Dr Balch proposed a framework combining 2 complementary sets of information: clinical evidence describing the disease and treatment options, and patient-specific information describing lived experiences, needs, and preferences.

He suggested that integrating these perspectives could help clinical pathways support appropriate treatment customization without compromising evidence-based care.

Incorporating Patient Perspectives Into Pathway Development

Beyond individual treatment decisions, the panelists emphasized the importance of involving patients directly in the development of clinical pathways.

Sabo-Wagner encouraged greater patient participation early in the pathway development process, including discussions about treatment experiences, logistical challenges, and opportunities to improve care delivery.

Dr Balch noted that most existing pathways are designed primarily for clinicians and may not adequately incorporate information about patients' daily circumstances.

He argued that patients should not need extensive clinical knowledge to participate meaningfully in treatment decisions.

Instead, patients contribute expertise about their experiences, priorities, and individual needs.

The panelists also addressed whether patients should know when their clinicians are using a clinical pathway.

Dr Balch supported greater transparency, particularly when pathway recommendations influence treatment selection or access.

He emphasized that explaining a pathway should create opportunities for shared decision-making rather than simply communicating a predetermined recommendation.

The discussion also highlighted the importance of reassessing patient preferences throughout treatment, particularly as priorities may change with disease progression or additional lines of therapy.

Real-World Data and AI May Support More Personalized Pathways

Looking ahead, panelists identified real-world evidence and AI as potential tools for integrating clinical and patient-reported information into oncology pathway development.

Sabo-Wagner suggested that AI could help clinicians evaluate how individual patients may respond to treatment by incorporating both clinical characteristics and social circumstances.

Dr Miksad similarly noted that real-world data may provide insights into patient experiences and treatment outcomes that are not fully captured in traditional clinical trials.

These technologies could potentially support more individualized discussions about treatment options, although their implementation and clinical utility require further evaluation.

The panelists emphasized that technological advances should complement, rather than replace, patient-clinician communication and shared decision-making.

Implications for Oncology Clinical Pathways

The session highlighted opportunities for oncology pathway developers, payers, and care delivery organizations to incorporate patient-centered considerations more systematically.

These include assessing transportation and caregiver needs, identifying financial hardship, improving navigation services, and involving patients directly in pathway development.

The panelists also emphasized the importance of generating more representative evidence that captures the experiences of patients across socioeconomic and geographic populations.

Integrating these factors into pathway design may help reduce barriers to appropriate care while maintaining the clinical consistency that pathways are intended to support.

Conclusion

At CPC 2026, panelists emphasized that patient-centered oncology pathways require the integration of clinical evidence with individual patient circumstances, preferences, and lived experiences.

Advances in patient navigation, shared decision-making, real-world evidence, and AI may help support more comprehensive treatment planning.

Ultimately, the discussion reinforced the importance of developing clinical pathways that standardize evidence-based care while preserving the flexibility necessary to meet individual patient needs.

Reference 

Balch A, Miksad R, Sabo-Wagner S. Elevating the patient voice in pathway development. Session presented at: Clinical Pathways Congress; November 10-11, 2026; Boston, MA.