‘Fast-track’ pathway for resectable pancreatic cancer: barriers and facilitators to implementation across a regional network

Introduction The National Institute for Health and Care Excellence guidelines recommend a ‘fast-track’ approach to avoid preoperative biliary drainage (PBD) when treating resectable pancreatic cancer. For reasons not yet known, there is variable uptake of this approach across the UK. A ‘fast-track’ pathway which avoids PBD was introduced in University Hospitals Birmingham NHS Foundation Trust (UHB) and referring centres in 2015. Methodology Eleven semi-structured interviews were conducted with members of the hepatobiliary multidisciplinary team (MDT) in UHB and referring centres. Barriers and facilitators to pathway implementation were assessed. Results Facilitators underpinning implementation were collaboration between stakeholders, clinical leadership and careful coordination of referrals. Barriers to implementation included clinician opposition and increased workload. Barriers were mitigated through phased implementation and the appointment of dedicated staff. Conclusion Future work may focus on exploring contextual factors in other tertiary centres and evaluating the emotional impact of ‘fast-tracked’ versus delayed surgery in patients with resectable pancreatic cancer.