Multi-stakeholder Working Group Research Articles

Regional Formularies in Italy: current state and future perspectives

Regional Formularies (RF) are considered part of pharmaceutical policies implemented by regions to govern access of medicines to regional market. However, they have been actually challenged, because of their presumed impact on differences of patient’s access across the regions. The paper aimed at investigating the current status of RF and Regional Therapeutic Committees (CTR) and at suggesting/recommending possible reforms. The current status was investigated through a questionnaire administered to the regional pharmaceutical departments. Recommendations were retrieved from a multi-stakeholder work group carried out on 30-31 March 2023, embedded into a Forum focused on the regional pharmaceutical policies. Nineteen out of twenty-one regions responded to the survey: 12 use RF, mainly managed by the CTR; the RF frequency of update and the time needed for drugs listing greatly vary across regions; pharmacists, specialists and general practitioners are always represented in CTR, whereas other healthcare professionals and experts are more rarely involved; in 3 regions the CTR does not publish any RF update; the CTR mainly rely, to take decisions, on the dimension of the target population, the cost of therapy compared to alternative treatments and the impact on pharmaceutical expenditure. The working group recommended to overcome the RFs, if they are merely considered a list of available drugs at regional level, focusing CTR activities to ensure market access and to govern the prescribing behaviour, and strengthening/anticipating the flow of information from the Italian Medicines Agency (AIFA) to the regions, to enable a more efficient approach to local access to drugs.

Best Practices for Communicating a Diagnosis of Dementia: Results of a Multi-Stakeholder Modified Delphi Consensus Process.

Many individuals with dementia and their families report not receiving a dementia diagnosis. Previously published standards for delivering a dementia diagnosis are now more than 10 years old and were developed without patient and caregiver input. The objective of this study was to identify best practices for delivering a diagnosis of dementia using existing literature, involvement of diverse stakeholders, and consensus building through a formal modified Delphi approach. We convened a multi-stakeholder working group including a patient, caregivers, Alzheimer's Association staff, and clinicians from diverse backgrounds. The panel used the American Academy of Neurology process for recommendation development, consisting of a half-day workshop and 3 rounds of anonymous modified Delphi voting to achieve consensus. The working group convened from May 2022 through January 2023. The group chose to focus statements on a limited number of best practices that can be applied across clinic types. Seven best practice statements achieved consensus after a maximum of 3 rounds of voting. These included the following: (1) Clinicians must show compassion and empathy when delivering a diagnosis of dementia (level A). During dementia diagnosis disclosure, clinicians should (2) ask regarding diagnosis preferences, (3) instill realistic hope, (4) provide practical strategies, (5) provide education and connections to high-quality resources, (6) connect caregivers to support resources, and (7) provide written summaries of the diagnoses, plan, and relevant resources (each level B). Clinicians need to customize discussion of a dementia diagnosis for individual patients and their caregivers. These 7 best practices provide a diagnosis communication framework that can be implemented across varied clinical settings. Additional strategies, such as using optimal general communication approaches, are also important for dementia diagnosis discussions. Thoughtful application of these best practices is particularly important when caring for individuals from underrepresented communities. Further improving communication regarding dementia diagnoses will require health system changes (e.g., for sufficient time), improved access to specialty dementia care, and clinician training for delivering difficult diagnoses. More research is needed to identify culturally sensitive approaches to discussing dementia diagnoses.

Co-creation of the Global Patient Experience Data Navigator: a multi-stakeholder initiative to ensure the patient voice is represented in health decision-making

BackgroundPutting patients’ needs and priorities at the forefront of healthcare initiatives and medical product development is critical to achieve outcomes that matter most to patients. This relies on the integration of early, meaningful patient engagement (PE) to learn what is important to patients, and collection of representative patient experience data (PXD). The increased number of PE/PXD efforts across global regulatory, health technology assessment, and healthcare systems is an important step forward to deliver improved health outcomes for patients. However, these initiatives are fragmented and lack integration, which is necessary to maximize efforts and reduce burden on patients. To overcome these challenges, the Global Patient Experience Data Navigator has been co-created by Patient Focused Medicines Development to provide practical resources that can facilitate and optimize PXD generation, collection, analysis, and dissemination for patient benefit and aims to be applicable across all therapeutic areas for all stakeholders.MethodsCo-creation of the Navigator took place through an iterative process of validation and formalization driven by a diverse, multi-stakeholder working group with individuals who have varying knowledge/experience in PE/PXD.ResultsA series of workshops took place to conduct a gap analysis, develop a taxonomy model, and integrate existing frameworks. The collective insights led to the development of the Navigator consisting of four specific tools in the form of downloadable templates, which can be used to: (1) prioritize outcomes that matter most to patients and their caregivers; (2) select appropriate measurement methods for these outcomes; (3) identify when and why PXD is used throughout the product development cycle for each stakeholder; (4) identify when and why PXD is used throughout the healthcare process for each stakeholder. A public consultation was carried out to collect user feedback before the Navigator was made publicly available in December 2022.ConclusionTo our knowledge, the Global Patient Experience Data Navigator is the only publicly available toolkit developed with a multi-stakeholder and disease-agnostic approach providing taxonomically grouped resources to optimize the collection and collation of PXD for patient benefit. Future work will aim to further engage patients by adding a PE dimension to the Navigator.

Expanding health technology assessment towards broader value: Ireland as a case study.

Healthcare innovations often represent important improvements in population welfare, but at what cost, and to whom? Health technology assessment (HTA) is a multidisciplinary process to inform resource allocation. HTA is conventionally anchored on health maximization as the only relevant output of health services. If we accept the proposition that health technologies can generate value outside the healthcare system, resource allocation decisions could be suboptimal from a societal perspective. Incorporating "broader value" in HTA as derived from social values and patient experience could provide a richer evaluative space for informing resource allocation decisions. This article considers how HTA is practiced and what its current context implies for adopting "broader value" to evaluating health technologies. Methodological challenges are highlighted, as is a future research agenda. Ireland serves as an example of a healthcare system that both has an explicit role for HTA and is evolving under a current program of reform to offer universal, single-tier access to public services. There are various ways in which HTA processes could move beyond health, including considering the processes of care delivery and/or expanding the evaluative space to some broader concept of well-being. Methods to facilitate the latter exist, but their adaptation to HTA is still emerging. We recommend a multi-stakeholder working group to develop and advance an international agenda for HTA that captures welfare/benefit beyond health.

Stakeholders' Perception of Bioenergy Projects in Marginal and Underutilized Lands in Italy

Large land areas in European countries can be considered marginal, underutilized, and contaminated (MUC). Many recent studies have shown that bioenergy crop cultivation can make this land profitable, creating new income opportunities for local citizens without interfering with food production. However, farmers, landowners, and local communities must become more familiar with bioenergy systems, potential value chains, and markets. This paper aims to present the results of stakeholder consultations implemented in two case study areas in Italy, i.e., Basilicata and Sardinia, about the possible establishment of bioenergy systems in the MUC land available at the local level. Stakeholders' perceptions were collected through interviews conducted on a one-to-one basis and through multi-stakeholder working group meetings organized in the context of BIOPLAT-EU, an H2020 project aimed at promoting the efficacy and profitability of using MUC land for sustainable bioenergy production. By and large, the findings of the consultations indicate that local stakeholders are prone to accept the establishment of innovative bioenergy value chains based on the cultivation of MUC lands in their regions. The majority of them recognized that bioenergy could bring a wide range of benefits at the local level, not only in terms of environmental externalities but also of economic and social development, such as through the creation of new business and job opportunities, therefore serving to alleviate or prevent the land abandonment and population decline currently on-going in these areas.

A practical ‘How-To’ Guide to plain language summaries (PLS) of peer-reviewed scientific publications: results of a multi-stakeholder initiative utilizing co-creation methodology

BackgroundPeer-reviewed scientific publications and congress abstracts are typically written by scientists for specialist audiences; however, patients and other non-specialists are understandably interested in the potential implications of research and what they may mean for them. Plain language summaries (PLS)—summaries of scientific articles in easy-to-read language—are emerging as a valuable addition to traditional scientific publications. Co-creation of PLS with the intended audience is key to ensuring a successful outcome, but practical guidance on how to achieve this has been lacking.MethodsBuilding on the Patient Engagement (PE) Quality Guidance previously developed by Patient Focused Medicines Development (PFMD), a multi-stakeholder working group (WG) of individuals with patient engagement experience and/or expertise in PLS was established to develop further activity-specific guidance. PLS guidance was developed through a stepwise approach that included several rounds of co-creation, public consultation (two rounds), internal review and a final external review. The iterative development process incorporated input from a wide variety of stakeholders (patient representatives, industry members, publishers, researchers, medical communications agencies, and public officials involved in research bodies). Feedback from each step was consolidated by the WG and used for refining the draft guidance. The final draft was then validated through external consultation.ResultsThe WG comprised 14 stakeholders with relevant experience in PE and/or PLS. The WG developed a set of 15 ethical principles for PLS development. These include the necessity for objective reporting and the absence of any promotional intent, the need for balanced presentation, the importance of audience focus, the need to apply health literacy principles, and the importance of using inclusive and respectful language. The first public consultation yielded 29 responses comprising 478 comments or edits in the shared draft guidance. The second public consultation was an online survey of 14 questions which had 32 respondents. The final ‘How-To’ Guide reflects feedback received and provides a rational, stepwise breakdown of the development of PLS.ConclusionsThe resulting ‘How-To’ Guide is a standalone, practical, ready-to-use tool to support multi-stakeholder co-creation of PLS.

Quality Measure Concepts to Fill Gaps in Assessing Oral Oncolytic Adherence: A Multistakeholder Measurement Strategy

Oral oncolytics affect the way oncology providers and their patients manage treatment. Patients with cancer often prefer oral therapies; however, at-home oral treatments may lead to increased non-adherence. Medication adherence quality measures have been used to monitor adherence for other medication types, but none exist for oral oncolytic therapies. A multistakeholder workgroup of oncology and quality measurement experts explored gaps in quality measures focused on oral oncolytic adherence and identified, prioritized, and refined measure concepts for further development. The workgroup prioritized measure gaps and developed measure concepts to assess priority factors impacting adherence: 1) screening for oral oncolytic medication access challenges and 2) bidirectional patient and provider communication regarding oral oncolytic treatment. They further prioritized development of medication persistence rate and discontinuation rate measures. The workgroup then identified action steps to advance the measure concepts, including evidence generation, agreement on best practices to support adherence, identification and use of patient-reported outcomes measures and tools, and integration of measurement data components into existing workflows. Pursuing these recommendations will require collaboration across stakeholders.

Oncology alternative payment models: lessons from commercial insurance.

Many payers and clinicians are committed to advancing value-based care through the establishment of alternative payment models (APMs) that incentivize practices and clinicians to improve quality and reduce cost. Amultistakeholder working group has observed that in specialty fields such as oncology, despite many attempts to design and implement APM pilots for commercial and Medicare Advantage populations, practical challenges and small numbers of episodes and patients present headwinds to viability and scalability. Despite this, some payers report emerging good practices and are optimistic about APMs. Careful and realistic consideration of the specific goals of a proposed model is warranted, as is close examination of the feasibility of transferring risk.

A framework for interprofessional team collaboration in a hospital setting: Advancing team competencies and behaviours.

Healthcare teams that practice collaboratively enhance the delivery of person-centred care and improve patient and systems outcomes. Many organizations have adopted existing interprofessional frameworks that define the competencies of individual health professionals that are required to meet practice standards and advance interprofessional goals. However, to support the collective efforts of team members to deliver optimal care within complex hospital settings, healthcare organizations may benefit from adopting team-based competencies for interprofessional collaboration. The Sunnybrook framework for interprofessional team collaboration was intentionally created as a set of collective team competencies. The framework was developed using a comprehensive literature search and consensus building by a multi-stakeholder working group and supported by a broad consultation process that included patient representation, organizational development and leadership, and human resources. The six core competencies are actionable and include associated team behaviours that can be easily referenced by teams and widely implemented across the hospital.

Sustainable Development Goals (SDG) indicators for municipalities: a comprehensive monitoring approach from Germany

Abstract While the 2030 agenda addresses the United Nation member states primarily at their national levels, municipalities play a crucial role in implementing all of the 17 SDGs and many of the 169 targets. These processes must be monitored and evaluated. However, the UN indicators are not sufficiently applicable to the local context. Therefore, a multi-stakeholder working group was formed in Germany to develop a comprehensive set of Sustainable Development Goal (SDG) indicators for municipalities, together with additional instruments to support local SDG monitoring such as an SDG data portal. The first catalogue which included 47 core SDG indicators was published in 2018. According to consecutive evaluations and practical tests, the indicator set was substantially expanded and revised to a final number of 120 SDG indicators. About half of the 120 indicators are provided with local-level data and the other half must be assessed individually for comprehensive local SDG monitoring. Likewise, accompanying tools were relaunched with additional functionalities. Although this new and unique set of indicators now covers a majority of the municipally relevant targets, there are still some decisive monitoring gaps for various reasons. The strengths and weaknesses of our methodological approach, as well as implications for future research and practical developments, are discussed.

Opportunities and challenges related to saturation of toxicokinetic processes: Implications for risk assessment

Top dose selection for repeated dose animal studies has generally focused on identification of apical endpoints, use of the limit dose, or determination of a maximum tolerated dose (MTD). The intent is to optimize the ability of toxicity tests performed in a small number of animals to detect effects for hazard identification. An alternative approach, the kinetically derived maximum dose (KMD), has been proposed as a mechanism to integrate toxicokinetic (TK) data into the dose selection process. The approach refers to the dose above which the systemic exposures depart from being proportional to external doses. This non-linear external-internal dose relationship arises from saturation or limitation of TK process(es), such as absorption or metabolism. The importance of TK information is widely acknowledged when assessing human health risks arising from exposures to environmental chemicals, as TK determines the amount of chemical at potential sites of toxicological responses. However, there have been differing opinions and interpretations within the scientific and regulatory communities related to the validity and application of the KMD concept. A multi-stakeholder working group, led by the Health and Environmental Sciences Institute (HESI), was formed to provide an opportunity for impacted stakeholders to address commonly raised scientific and technical issues related to this topic and, more specifically, a weight of evidence approach is recommended to inform design and dose selection for repeated dose animal studies. Commonly raised challenges related to the use of TK data for dose selection are discussed, recommendations are provided, and illustrative case examples are provided to address these challenges or refute misconceptions.

Working Together for Grizzly Bears: A Collaborative Approach to Estimate Population Abundance in Northwest Alberta, Canada

Grizzly bears are a threatened species in Alberta, Canada, and their conservation and management is guided by a provincial recovery plan. While empirical abundance and densities estimates have been completed for much of the province, empirical data are lacking for the northwest region of Alberta, a 2.8 million hectare area called Bear Management Area 1 (BMA 1). In part, this is due to limited staff capacity and funding to cover a vast geographic area, and a boreal landscape that is difficult to navigate. Using a collaborative approach, a multi-stakeholder working group called the Northwest Grizzly Bear Team (NGBT) was established to represent land use and grizzly bear interests across BMA 1. Collectively, we identified our project objectives using a Theory of Change approach, to articulate our interests and needs, and develop common ground to ultimately leverage human, social, financial and policy resources to implement the project. This included establishing 254 non-invasive genetic hair corral sampling sites across BMA 1, and using spatially explicit capture-recapture models to estimate grizzly bear density. Our results are two-fold: first we describe the process of developing and then operating within a collaborative, multi-stakeholder governance arrangement, and demonstrate how our approach was key to both improving relationships across stakeholders but also delivering on our grizzly bear project objectives; and, secondly we present the first-ever grizzly bear population estimate for BMA 1, including identifying 16 individual bears and estimating density at 0.70 grizzly bears/1,000 km2-the lowest recorded density of an established grizzly bear population in Alberta. Our results are not only necessary for taking action on one of Alberta's iconic species at risk, but also demonstrate the value and power of collaboration to achieve a conservation goal.

Science Diplomacy in Emerging Economies: A Phenomenological Analysis of the Colombian Case.

Little has been investigated about Science Diplomacy (SD) in emerging economies, more specifically on governance schemes useful for organizing intersecting actors, practices, conceptions and suggestions of the future in foreign affairs and Science, Technology and Innovation (STI) in public administration sectors. This paper contributes to a better understanding of the “texture and nature” of SD initiatives in emerging economies through the eyes of relevant actors involved or reflecting about them in Colombia. The aim of this paper is to propose a general governance scheme for SD in emerging economies and its potential instrumentation for a policy-mix. In Colombia, SD initiatives are very fragmented, and are not part of the priorities of the Colombian state, however the increasing interest of an embryonic practitioner and scholar community working in the topic make necessary this work. A phenomenological perspective combined with a single case study research methodology is used to gain a very accurate description of the state of the situation of SD in Colombia. Policy document review and semi-structured interviews were conducted with 18 relevant actors to understand the conceptions, practices, and suggestions for the future of SD in Colombia. The study results show that SD actors in Colombia are scattered, practices strongly related to traditional cooperation diplomatic activities and the need to give a function to SD for capacity building, better global intermediation and the development of new knowledge, in particular promoting SD abilities in the scientific community. In addition, data expresses the need to cultivate a multi-stakeholder working group for such a purpose. The study reflects on the need of a policy mix for SD in emerging economies. It proposes a general governance scheme for it, a potential instrumentation founded on research participant future suggestions, and a set of practical recommendations and policy implications. Conclusions and further research questions are set, pointing out the importance of including non-conventional diplomacy actors and knowledge, and the need to inquire rationales behind possible SD policy mixes in the southern world.

Accelerating Advances in Cancer Care Research: A Lookback at the 21st Century Cures Act in 2020.

The 21st Century Cures Act (Cures Act), signed into law in 2016, was designed to advance new therapies by modernizing clinical trials, funding research initiatives, and accelerating the development and use of health information technology. To analyze the current issues in cancer care related to the implementation and impact of the Cures Act, NCCN convened a multistakeholder working group. Participants discussed the legislation's impact on the oncology community since enactment and identified the remaining gaps and challenges as experienced by stakeholders. In June 2020, the policy recommendations of the working group were presented at the virtual NCCN Policy Summit: Accelerating Advances in Cancer Care Research: A Lookback at the 21st Century Cures Act in 2020. The summit consisted of informative discussions and a multistakeholder panel to explore the recommendations and the future of the Cures Act. This article explores identified policy recommendations from the NCCN Working Group and the NCCN Policy Summit, and analyzes opportunities to advance innovative cancer care and patient access to data.

Identifying Research Priorities in Adult Day Centers to Support Evidence-Based Care of Vulnerable Older Adults.

Adult day centers (ADCs) are essential community resources that allow frail older adults to remain in their communities. Research demonstrates that ADC staff have the capacity to leverage their culturally and socially congruent relationships with clients and caregivers, to deliver evidence-based interventions that improve health outcomes. Yet, they remain a largely overlooked neighborhood resource for older adults with complex health care needs. The National Adult Day Services Association (NADSA) created a multistakeholder work group to identify priority areas for research to enhance the quality of services offered in ADCs and the delivery of evidence-based practices to clients. This perspective piece, which presents the workgroup's findings in the form of key research priorities, is intended as practical guide for researchers seeking to align their research questions with the needs of ADCs and those they serve. In addition to identifying areas of further exploration, we discuss current studies being undertaken within the ADC setting.

Expanding Access to Lung Cancer Clinical Trials by Reducing the Use of Restrictive Exclusion Criteria: Perspectives of a Multistakeholder Working Group

Low rates of adult patient participation have been a persistent problem in cancer clinical trials and have continued to be a barrier to efficient drug development. The routine use of significant exclusion criteria has contributed to this problem by limiting participation in studies and creating significant clinical differences between the study cohorts and the real-world cancer patient populations. These routine exclusions also unnecessarily restrict opportunities for many patients to access potentially promising new therapies during clinical development. Multiple efforts are underway to broaden eligibility criteria, allowing more patients to enroll in studies and generating more robust data regarding the effect of novel therapies in the population at large. Focusing specifically on lung cancer as an example, a multistakeholder working group empaneled by the LUNGevity Foundation identified 14 restrictive and potentially outdated exclusion criteria that appear frequently in lung cancer clinical trials. As a part of the project, the group evaluated data from multiple recent lung cancer studies to ascertain the extent to which these 14 criteria appeared in study protocols and played a role in excluding patients (screen failures). The present report describes the working group’s efforts to limit the use of these routine exclusions and presents clinical justifications for reducing the use of 14 criteria as routine exclusions in lung cancer studies, potentially expanding trial eligibility and improving the generalizability of the results from lung cancer trials.

A Multidisciplinary Consensus Recommendation on a Synoptic Radiation Treatment Summary: A Commission on Cancer Workgroup Report

PurposeThe radiation treatment summary provides a clinical and technical overview of a patient’s full course of radiation therapy. Despite its importance to multiple stakeholders, there is no widely followed radiation treatment summary template. Methods and MaterialsThe Commission on Cancer convened a multistakeholder workgroup to develop a synoptic radiation treatment summary template. The workgroup included individuals with expertise in radiation, medical and surgical oncology, medical physics, oncology informatics, cancer registry, electronic medical record systems, treatment planning systems, and registry information systems. The workgroup iterated a template until consensus was achieved. ResultsThe consensus radiation treatment summary template is divided into 3 sections that allows for a mix of structured and free text. The first section, “Radiation Course Summary,” is meant to provide information that is of broad interest and in a manner that is potentially accessible to patients, their families, and nononcology-trained care team members. The second section, “Anatomic Target Summary,” provides information that is potentially useful to oncology-trained care team members who will be primarily interested in which anatomies were irradiated, by what modality, and to what cumulative dose. The third section, “Delivered Prescriptions,” summarizes technical information that is primarily of interest and accessible to radiation oncology-trained clinicians, registrars, and researchers. ConclusionsWe have proposed a consensus template with 3 sections to meet the needs of a diverse set of consumers. We recommend that providers, professional societies, and accreditation bodies with interest in the radiation treatment summary continue collaborative efforts to test, iterate, and drive adoption of a synoptic template.

Updates to the HL7 2.5.1 Implementation Guide for Syndromic Surveillance

Updates to the HL7 2.5.1 Implementation Guide for Syndromic Surveillance

PNS147 A FRAMEWORK FOR VETTING "GOOD” OUTCOMES-BASED MEASURES IN ALTERNATIVE PAYMENT MODELS

Alternative payment models (APMs) are part of a growing trend to shift away from volume-based, traditional fee-for-service payment models toward payment for value. APMs generally seek to achieve high-value care and reduce high cost, low-value care by incentivizing providers and their clinicians to make economical care decisions while a) maintaining or improving the quality of care, and b) linking pre-specified outcomes to quality measures related to financial performance-based payments. But how can stakeholders be confident we are truly measuring value? A major concern is that current measures lack the patient voice and inadequately reflect the quality of care provided, instead emphasizing utilization, cost and short-term complications. Using oncology as a learning case, we sought to explore how high quality, patient-informed core outcome sets (COS) developed for research might help improve the patient-centeredness of APMs. In doing so, we engaged a multi-stakeholder working group to identify and prioritize characteristics of “good” outcomes-based quality measures. We conducted a directed literature review, key informant interviews, web-based multi-stakeholder workgroup discussions and a COS vetting and prioritization exercise using the web-based survey platform Qualtrics. The following characteristics of “good” outcomes or outcomes-based quality measures in APMs were identified and prioritized as: clinically relevant, meaningful to patients, actionable, inclusive of important patient populations, feasible to observe (and measure) from data, associated with observable differences in a reasonable amount of time, associated with cost savings, and associated with minimal burden on providers. Based on our exploration of how COS can help improve the patient-centeredness of APMs, we propose a framework to guide future discussions engaging providers, payers, clinicians and patients to select appropriate and relevant outcomes-based measures for APMs and other value-based payment initiatives. This framework can help connect what patients value in research to the systems that are shaping reimbursement policies and influencing the experience and decision-making of the patient-clinician encounter.

Policy Challenges and Opportunities to Address Changing Paradigms in Cancer Care Delivery.

Multiple factors are forcing the healthcare delivery system to change. A movement toward value-based payment models is shifting these systems to team-based integration and coordination of care for better efficiencies and outcomes. Workforce shortages are stressing access and quality of care for patients with cancer and survivors, and their families and caregivers. Innovative therapies are expensive, forcing payers and employers to prioritize resources. Patients are advocating for care models centered on their needs rather than those of providers. In response, payment policies have recently focused on the promotion of alternative payment models that incentivize coordinated, high-quality care with consideration for value and controlling the increasing overall costs associated with cancer and its treatment. Given the multitude of factors confounding cancer care, NCCN convened a multistakeholder working group to examine the challenges and opportunities presented by changing paradigms in cancer care delivery. The group identified key challenges and developed policy recommendations to address 4 high-visibility topics in cancer care delivery. The findings and recommendations were then presented at the NCCN Policy Summit: Policy Challenges and Opportunities to Address Changing Paradigms in Cancer Care Delivery in September 2018, and multistakeholder roundtable panel discussions explored these findings and recommendations along with additional items. This article encapsulates the discussion from the NCCN Working Group meetings and the NCCN Policy Summit, including multistakeholder policy recommendations on delivery issues in cancer care designed to help inform national policies moving forward.