Personalised Medicine in shaping sustainable healthcare: a Delphi survey within the IC2PerMed project

Background

Personalised medicine (PM) has the potential to transform health systems and make them more sustainable, by making the population healthier and allocating resources efficiently. European Union and China have become world leaders in the field of PM, increasing collaborations worldwide. In this context, the EU Commission in 2020 launched the IC2PerMed (Integrating China in the International Consortium for Personalised Medicine) project to provide key solutions to enable the convergence of European and Chinese stakeholders toward a common approach in PM.

Methods

From a mapping exercise of policies and programs in PM in EU and China, we identified 20 priority items for shaping sustainable healthcare. Such items were submitted to several Chinese and European experts in PM involved in a 3-round Delphi survey. Experts were asked to review the items’ content and rate their validity and relevance on a 5-point Likert scale. Priorities reaching a Content Validity Index of more than 79% were included, between 70 and 79% were revised, and less than 70% were excluded.

Results

Of 20 priorities submitted, 9 reached consensus. The priorities hinge on the resources allocation, defining in advance priority investment, and identifying new payment models for public reimbursement, health technology impact, and assessment importance, while integrating end-user perceptions into the whole innovation process. In addition, the pivotal role of multidisciplinary and cross-sectorial collaborations emerged. Ethical, legal, and social implications and the related costs should be always considered in policymaking, evaluation, and management of technological innovation.

Conclusions

Integrating resources and setting a clear agenda for the implementation of PM would lead to a faster and more efficient translation into clinical practice. Developing policies valuing all the stakeholders’ contributions would implement PM adoption.

Key messages

• Healthcare systems sustainability is a priority and PM could make the population healthier and help allocate resources more efficiently, hence reducing the overall costs of healthcare.

• The inter-sectoral collaborations in healthcare are fundamental to achieving the best standard of care. All stakeholders and policymakers should engage to foster sustainability.

Combining personalised medicine and patient-centered care in breast cancer: a systematic review

Background

Breast Cancer (BC) is estimated to cause 2.3 million yearly new cases worldwide. Efforts towards standardized, quality assured and effective care have led to an increasing complexity and specialization of BC management. This systematic review's aim is to describe the state-of-the art of available literature investigating the enactment of personalised medicine and patient-centered care models in BC practice and build a framework towards personalised BC care within a patient-centered model.

Methods

Databases were searched to retrieve articles reporting on BC management, evaluated in terms of patient-centered and personalised medicine approaches, assessing success factors or limits, in English, from the inception to December 2020. The investigated dimensions for patient-centered care models were audits, communication, informative systems and multidisciplinarity. Concerning Personalised Medicine, investigations were related to molecular boards, genetic testing and shared-clinical decision-making.

Results

Out of 1885 records, 25 studies were included in the qualitative analysis. The main success factors are multi-professional collaborations with defined roles and responsibilities, training programs on genomic tools and adequate communication strategy (i.e universal genomic language) to involve patients in the decision-making process. Among detected barriers, delays in genetic testing use were linked to the lack of public reimbursement and of clarity in timing and appropriateness.

Conclusions

Both these models are complementary and needed to ensure effective changes in the path of BC patient management. Our framework aims to the transformation of standardized application of evidence-based medicine into a dynamic and personalised care pathway.

Key messages

The combination of the two care delivery approaches is scarcely investigated in literature. Our framework would allow to fill such gap and attributes a key role to sharing the decision-making process.

Major trauma critical pathway: preliminary results from the monitoring system in the regional network and in a hub center in Rome metropolitan area

OBJECTIVE

The aim of this study is to collect the two years' data regarding the Integrated Trauma Management System (SIAT) by capturing the activity of its three Hubs in the Italian Lazio Region and test the performance of one of the Hubs' (Fondazione Policlinico Universitario A. Gemelli - IRCCS, FPG -IRCCS) Major Trauma Clinical Pathway's (MTCP) monitoring system, introducing the preliminary results through volume, process and outcome indicators.

MATERIALS AND METHODS

A retrospective analysis on SIAT was conducted on years 2016 to 2018, by collecting outcome and timeliness indicators through the Lazio Informative System whereas the MTCP was monitored through set of indicators from the FPG - IRCCS Informative System belonging to randomly selected clinical records of the established period.

RESULTS

Hubs managed 11.3% of the 998,240 patients admitted in SIAT. All patients eligible for MTCP were "Flagged", and 83% underwent a CT within 2 hours; intra-hospital mortality was 13% whereas readmission rates 16.9%.

CONCLUSIONS

SIAT converges the most severe patients to its Hubs. The MTCP monitoring system was able to measure a total of 9 out of 13 indicators from the original panel. This research may serve as a departing point to conduct a pre-post analysis on the performance of the MTCP.