Abstract
Background: As older adults constitute a growing segment of the population, multimorbidity, defined as the presence of two or more health conditions, is increasingly prevalent. Among individuals aged 65 to 84, 65% experience multimorbidity, rising to 81% for those aged 85 and older. This condition often leads to a diminished quality of life, significant disease burden, impaired health outcomes, and heightened risk of premature mortality. Current healthcare systems, typically organized around single-disease models, are inadequately equipped to meet the complex needs of multimorbid patients, resulting in suboptimal care and higher healthcare costs. Integrated, patient-centered care has demonstrated benefits for multimorbid patients, but the implementation and evaluation of such models are challenging. Cancer, a condition frequently coexisting with other health issues, serves as an excellent model for the development of integrated care approaches. Indeed, cancer already benefit from a multidisciplinary management model; however, cancer care pathways vary widely across Europe. This study will address two research questions: What are the existing care pathways for multimorbid patients with cancer in Europe? And what are the costs associated with managing multimorbid patients, and what factors influence these costs?
Approach: The IMPLEMENT study seeks to provide a comprehensive description of the oncology care pathway for older multimorbid patients across five countries in Europe from patient, clinical, organizational, implementation, and economic perspectives. We adopt an observational cross sectional study design that involves the systematic observation of several clinical sites across 5 European Countries. We use mixed-method approach combining both qualitative and quantitative data collection techniques to capture a wide range of perspectives and insights. By integrating observational methods (where appropriate such as clinician’s non-patient work routines), surveys, interviews and focus groups with key, relevant stakeholders, namely oncologists, geriatricians, APNs/nurses, and data managers, we aim to achieve a more holistic understanding of the stakeholders' practices, views, experiences, and needs. The IMPLEMENT study is part of the GERONTE Project, a 5-year initiative funded by the European Union under the H2020 Research and Innovation program, that seeks to enhance the quality of life for older multimorbid patients while reducing overall care costs.
Results: The insights emerged from the interviews confirmed an initial hypothesis: high variability in resource use and related costs should be expected from the sites involved in the study. Indeed, the organizational context in which each trial site is embedded affects its operating conditions. Starting from this general statement, the evidence from the interviews highlighted that the delivery of patient care depends on a combination of at least three elements: a) the scope of the services offered by each clinical site within the care pathway; b) the relationships between health care professionals, including access to specialist knowledge; c) the tools available to ensure integration between the different professionals in the different stages of the care pathway.
Implications: The study provides a comprehensive overview of cancer care pathway in five European countries, providing insights from experiences into the transition from fragmented to integrated care models for multimorbid patients