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Ann Oncol. 2015 Sep;26(9):1953-9. doi: 10.1093/annonc/mdv269. Epub 2015 Jun 18.

Indicators of integration of oncology and palliative care programs: an international consensus.

Author information

1
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA dhui@mdanderson.org.
2
Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
3
Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland.
4
Department of Palliative and Supportive Care and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
5
Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
6
Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland, USA.
7
Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
8
European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
9
Palliative and Supportive Services, Flinders University, Adelaide, South Australia.
10
Duke Clinical Research Institute, Duke University School of Medicine, Durham, USA.
11
Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada.

Abstract

BACKGROUND:

Recently, the concept of integrating oncology and palliative care has gained wide professional and scientific support; however, a global consensus on what constitutes integration is unavailable. We conducted a Delphi Survey to develop a consensus list of indicators on integration of specialty palliative care and oncology programs for advanced cancer patients in hospitals with ≥100 beds.

METHODS:

International experts on integration rated a list of indicators on integration over three iterative rounds under five categories: clinical structure, processes, outcomes, education, and research. Consensus was defined a priori by an agreement of ≥70%. Major criteria (i.e. most relevant and important indicators) were subsequently identified.

RESULTS:

Among 47 experts surveyed, 46 (98%), 45 (96%), and 45 (96%) responded over the three rounds. Nineteen (40%) were female, 24 (51%) were from North America, and 14 (30%) were from Europe. Sixteen (34%), 7 (15%), and 25 (53%) practiced palliative care, oncology, and both specialties, respectively. After three rounds of deliberation, the panelists reached consensus on 13 major and 30 minor indicators. Major indicators included two related to structure (consensus 95%-98%), four on processes (88%-98%), three on outcomes (88%-91%), and four on education (93%-100%). The major indicators were considered to be clearly stated (9.8/10), objective (9.4/10), amenable to accurate coding (9.5/10), and applicable to their own countries (9.4/10).

CONCLUSIONS:

Our international experts reached broad consensus on a list of indicators of integration, which may be used to identify centers with a high level of integration, and facilitate benchmarking, quality improvement, and research.

KEYWORDS:

access; health systems; indicators; integration; neoplasms; palliative care

PMID:
26088196
PMCID:
PMC4551157
DOI:
10.1093/annonc/mdv269
[Indexed for MEDLINE]
Free PMC Article

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