Integration of Oncology and Palliative Care Programs: An International Consensus

Many national and international professional organizations have called for increased integration of oncology and palliative care in order to meet the supportive care needs of cancer patients, but to date, there has been a lack of a global consensus on an acceptable level of integration of oncology and palliative care. Study Group members initiated a Delphi survey (three iterations) to develop an international consensus on indicators for the integration of specialty palliative care and oncology programs for hospitalized advanced cancer patients. Respondents, mostly from North America and Europe, reached consensus on 13 major and 30 minor indicators. Major indicators were related to clinical structure (e.g., presence of palliative care inpatient team), processes (e.g., early palliative care referral), outcomes (e.g., median time from diagnosis to palliative care consultation), and education (e.g., routine rotation of oncology fellows to palliative care). The indicators can be used to identify centers with a high level of integration and to facilitate benchmarking, quality improvement, and research.

The results of this study are most relevant to tertiary care hospitals and cancer centers. But, to the authors’ knowledge, this is the first study to examine system indicators on integration of oncology and palliative care. In the future, more attention should be focused on integration at the community level and the delivery of optimal palliative care by oncology professionals. The authors conclude that these indicators represent milestones toward the vision of integration. Such implementation will likely proceed in a stepwise fashion and will require long-term commitment from oncologists, palliative care specialists, educators, and hospital administrators, as well as proper funding, planning, documentation, and quality improvement, and cost-effectiveness studies.

Results from this and future studies can help policy makers and administrators set goals for their programs, assess a hospital’s performance, standardize the care provided, and develop quality improvement projects. Further, they can help referring physicians to recognize hospitals that offer integrated palliative care services. Organizations can use these agreed-upon indicators to recognize cancer centers and hospitals that have achieved a certain level of integration researchers can study the outcomes associated with integration.

Hui D, Bansal S, Strasser F, Morita T, Caraceni A, Davis M, et al. Indicators of integration of oncology and palliative care programs: an international consensus. Annals of Oncology 2015;26:1953-9.