Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study

Abstract

Abstract Purpose To identify elements of timely integration of palliative care (PC) in oncology hospital care from best practices. Thereafter, to assess the level of consensus among oncology and PC specialists and patient- and relative representatives on the characteristics of timely integration of PC. Methods A three round modified Delphi study was conducted. The expert panel consisted of 83 healthcare professionals (HCPs) from 21 Dutch hospitals (43 physicians, 40 nurses), 6 patient- and 2 relative representatives. The first round regarded four elements of integrated PC: (1) identification of potential PC needs (2), advance care planning (ACP), (3) routine symptom monitoring and (4) involvement of the specialist palliative care team (SPCT). In subsequent rounds, the panellists assessed which characteristics were triggers for initiating an element. Consensus was set a priori at ≥ 70%. Results A total of 71 (78%) panellists completed the first questionnaire, 65 (71%) the second, and 49 (54%) the third. Panellists agreed that in all patients with incurable cancer PC needs should be assessed (97%), symptoms monitored (91%) and ACP initiated (86%). The SPCT should be involved at the patient’s request (86%) or when patients suffer from increased symptom burden on multiple dimensions (76%). Patients with a life expectancy of < 3 months should be offered a consultation (71%). Conclusion The expert panel agreed that timely integration of PC into oncology is important for all patients with incurable cancer, using early identification, ACP and routine symptom monitoring. Involvement of the SPCT is specifically needed in patients with multidimensional symptom burden and in those nearing death.