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

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Abstract

Purpose

To identify elements of timely integration of palliative care (PC) into hospital oncology 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. In the first round, four elements of integrated PC were considered: (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. A priori consensus was set 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 all patients with incurable cancer should have their PC needs 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 less than 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 particularly needed in patients with multidimensional symptom burden and in those nearing death.

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Funding

This work was supported by the Maarten van der Weijden Foundation.

Author information

Authors and Affiliations

  1. Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands

    Carly S. Heipon, Linda Brom, Yvette M. van der Linden & Natasja J. H. Raijmakers

  2. Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands

    Yvette M. van der Linden

  3. Dutch Federation of Cancer Patients Organisations, Utrecht, the Netherlands

    Dorien Tange

  4. Department of Medical Oncology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands

    Anna K. L. Reyners

Authors
  1. Carly S. Heipon
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Contributions

All authors contributed to the study conception and design. CH, NR and LB conducted the data collection and analysis. YL, DR and AR contributed to the interpretation. CH drafted the manuscript. All authors were involved in the critical revision of the manuscript and approved the final version of the manuscript.

Corresponding author

Correspondence to Carly S. Heipon.

Ethics declarations

Ethics approval

This study was carried out in line with the principles of the Declaration of Helsinki. The Medical Ethics Committee of Brabant (METC NW2021-71) assessed the study and granted it exemption from full approval of an ethics committee due to the fact that there was no invasive intervention nor were there vulnerable patients involved (CCMO, 2020).

Consent to participate

Informed consent was obtained from all panellists included in the study.

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N/a.

Competing interests

The authors declare no competing interests.

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Heipon, C.S., Brom, L., van der Linden, Y.M. et al. Characteristics of timely integration of palliative care into oncology hospital care for patients with incurable cancer: results of a Delphi Study. Support Care Cancer 32, 324 (2024). https://doi.org/10.1007/s00520-024-08508-0

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