Timely integration of palliative care into oncology in hospitals in the Netherlands: a feasibility study

BACKGROUND: Timely integration of palliative care has numerous benefits for patients with incurable cancer. Based on a recent national Delphi study on the timely integration of palliative care in oncology, three recommendations were formulated regarding 1) advance care planning (ACP), 2) routine symptom monitoring during the last year of life, and 3) involving the Specialist Palliative Care Team (SPCT) during the last three months of life. This pilot study aimed to assess the feasibility of these recommendations in the Dutch context.

METHODS: Four Dutch hospitals implemented these recommendations for three months. Feasibility was assessed in three ways. First, the extent to which the recommendations were applied was assessed by analysis of electronic medical records (EMRs) of 542 patients with incurable cancer. Second, the extent to which clinicians (n = 27) found the recommendations applicable was assessed using a questionnaire including the Measurement Instrument for Determinants of Innovations (MIDI) and self-administrated questions. Last, patients' experiences (n = 70) were assessed using the EORTC IN-PATSAT and self-administrated questions regarding using the recommendations.

RESULTS: The recommendation on ACP was applied in 49% of eligible patients and the recommendation on symptom monitoring and SPCT in 58%. Most clinicians agreed that all three recommendations were important to achieve timely integration of palliative care (85%). The majority reported being able to conduct ACP discussions (78%), to consider involving the SCPT in case of complexity (73%), and to offer SPCT consultation in case of a life expectancy of ≤ 3 months (68%). A minority reported being able to pay attention to symptom monitoring across the four dimensions (42%) and to record outcomes in the EMR (19%). Patients who received care according to the recommendations were equally satisfied with care compared to those who received standard care, except when symptoms of social problems were monitored; these patients were more satisfied with care, respectively 83.1(SD 18.7) vs 71.2(SD 20.1).

CONCLUSIONS: Implementing the recommendations for timely integration of palliative care in daily clinical oncology practice seems feasible. The key is to address practical issues, including information exchange about ACP and symptom management among all involved clinicians.