Table 2

PC Optimal Care Pathway (OCP) mapped to modified Delphi quality indicators

PC OCP	OCP elements	Mapped quality indicators from modified Delphi consensus40
Step 1: Prevention and early detection	1.1 Prevention. 1.2 Risk factors. 1.3 Early detection.	Nil
Step 2: Presentation, initial investigations and referral	2.1 Signs and symptoms. 2.2 Assessments by general practitioner or medical practitioner. 2.3 Referral.	Documented baseline CA19-9 level before treatment. Documented ECOG and/or ASA at presentation. Time from referral to definitive treatment within 60 days.
Step 2: Presentation, initial investigations and referral	2.4, 3.5, 4.6, 5.4, 6.6 and 7.3 Support and communication	Nil
Step 3: Diagnosis, assessment and treatment planning	3.1 Diagnostic workup. 3.2 Staging. 3.3 Treatment planning.	Documented pancreatic protocol CT or MRI scan for diagnosis and/or staging. Operability of tumour is clearly defined and documented as either operable/resectable, borderline resectable, locally advanced (unresectable) or metastatic (unresectable). Disease management for all patients discussed at an MDT meeting.
	3.4, 4.4, 5.3, 6.5 and 7.2 Research and clinical trials	Number of patients included in a clinical trial.
	3.1 and 3.2 Timeframe	Time from referral to definitive treatment within 60 days.
Step 4: Treatment	4.1 Treatment intent	Nil
	4.2.1 Surgery (curative)	All patients who did not undergo surgery should have a valid reason documented. Number of patients undergoing PC surgery in a level 1–4 hospital.
	4.2.1 Chemotherapy or chemoradiation.	Adjuvant chemotherapy administered following surgery or a reason documented for not undergoing treatment.
	4.2.2 and 4.3 Treatment of unresectable PC/palliative care.	Chemotherapy±chemoradiation offered to patients with locally advanced disease, or a reason documented for not undergoing treatment. Number of patients who saw a medical or radiation oncologist or a reason documented for not doing so.
	4.5 Complementary or alternative therapies.	Nil
Step 5: Care after initial treatment and recovery	5.1 Survivorship. 5.2 Post-treatment care planning.	All patients having completed treatment followed up by a specialist every 3–6 months for up to 2 years.
Step 6: Managing recurrent, residual and metastatic disease	6.1 Signs and symptoms of recurrent, residual or metastatic disease.
Step 6: Managing recurrent, residual and metastatic disease			Step 7: End-of-life-care	6.4 Palliative care. 7.1 Multidisciplinary palliative care.	All patients with metastatic disease referred to (or seen by) palliative care specialist.

Some elements in each step of the pathway are overlapping. Elements 6.2 and 6.3 readdress steps 3 and 4. Please note: the purpose of this document is to provide a broad overview of the areas within the OCP that the developed PC quality indicators measure. Only the key indicators that map to the elements are listed.
ASA, American Society of Anesthesiologists (performance status); ECOG, Eastern Cooperative Oncology Group (performance status); MDT, Multidisciplinary Team.