Table 1. Logic model - Inputs and activities.

Background	Period prior to implementation of the integrated care pathway: A public teaching hospital specializing in oncology opened its doors in May 2008, to treat public healthcare system patients who had been diagnosed with cancer. Patients were admitted by medical oncologists or surgeons. Although the established multimodal treatment for middle or lower rectal cancer consisted of neoadjuvant chemoradiotherapy followed by surgical resection, there was no coordination between the phases, which harmed the continuity of care. Until 2010, radiotherapy was done in a different service.
Goal	To implement an integrated care pathway for neoadjuvant treatment of rectal cancer, consisting of radiotherapy with 5040 cGy delivered in 28 fractions (540 cGy in the boost phase and 4500 cGy in the pelvic phase), over a five-week period. Concomitant chemotherapy (FULV regimen12 with 350 mg/m2 of 5-fluorouracil and 20 mg/m2 of leucovorin) was delivered as two five-day courses during the first and fifth weeks of radiotherapy. Surgery with total mesorectal excision consisted of open rectosigmoid resection (ORR), laparoscopic rectosigmoid resection (LRR) or abdominoperineal resection (APR).
Objectives	To manage all steps of the treatment for middle and lower rectal cancer and provide multidisciplinary continuity of care.
Inputs
1. Service users	Inclusion Criteria: Patients with rectal cancer Exclusion Criteria: Patients with metastatic disease at diagnosis Patients who were unable to undergo neoadjuvant treatment: clinical condition precluded the use of nCRT; or immediate surgery was indicated; or a rapid course of neoadjuvant radiotherapy was indicated Patients who had previously been treated for cancer Patients who had not adhered to the nCRT regimen
2. Resources	Human Resources: medical oncologists, gastrointestinal surgeons, radiation oncologists, endoscopists, radiologists, pathologists, anesthesiologists, physicians, nurses, dieticians, social workers, psychologists, physiotherapists, hospital administrators and data managers
	Facilities: chemotherapy sector, radiotherapy sector, operating rooms, inpatient units, consultation rooms, imaging service and electronic medical records
Activities
1. Stakeholder engagement	Clinical staff engagement: Multidisciplinary meetings were held under the leadership of a board of directors. Medical oncologists, surgeons, radiation oncologists, radiologists, pathologists, clinicians and anesthesiologists reviewed the neoadjuvant treatment protocol for middle and lower rectal cancer and defined the intervals between the phases of the treatment.
2. Clinical pathway development	An integrated care pathway was designed as a flowchart by the administrative group. Identification of patients’ input into the clinical pathway Definition of the time interval between record screening and the first medical consultation Booking first medical consultations on the pathway Staging test standardization Definition of term reports Sharing of chemotherapy and radiotherapy session schedules Active monitoring of surgery requests Definition of time interval between neoadjuvant treatment and surgery
3. Information technology improvements	Enablement of pathway patient identification using a flag added to the electronic patient charts Development of a report to identify pathway patients who have consultations and tests scheduled Development of a report to identify pathway patients who do not have any scheduling Development of a report to calculate dates of future steps on the pathway, to help in reception sector scheduling Development of the flag deactivation process
4. Training program	Training program for outpatient reception workers to enable schedule tests and consultations in accordance with the flowchart Training program to enable use of the reports that have been developed Training program to activate flags: regulation sector Training program to deactivate flags: physicians