PURPOSE/OBJECTIVES: To explain the rationale and process of outpatient critical pathway development for sequential high-dose chemotherapy followed by peripheral blood stem cell transplantation. DATA SOURCES: Published books and journal articles. DATA SYNTHESIS: Complex treatment for patients with metastatic breast cancer is shifting to the outpatient area. To make this therapy safe and cost effective, a process for monitoring this type of outpatient care needs to be developed. CONCLUSIONS: Collaboration with a multidisciplinary team is important in ensuring quality of care for complex outpatient treatment protocols. Critical pathway development can serve as a road map for delivering this care. IMPLICATIONS FOR NURSING PRACTICE: As team leaders, nurses should oversee the critical pathway development and implementation. Nurses also should maintain their role of patient advocacy through monitoring pathway compliance.