Integrated Palliative Care in Oncology: a Protocol for a Realist Synthesis

Overview

Journal BMJ Open

Specialty General Medicine

Date 2024 Feb 17

PMID 38367978

Authors

Joanne Reid

Elspeth Banks

Carolyn Blair

Natasha Bradley

Fiona A Lynn

Peter OHalloran

Gillian Prue

Nia Roberts

Geoff Wong

Tracey McConnell

Affiliations

Soon will be listed here.

Abstract

Introduction: Emerging evidence suggests improved quality of life, reduced symptom burden and lower health services costs when integrated palliative care and cancer care are implemented. Integrated palliative care aims to achieve care continuity by integrating organisational, administrative and clinical services involved in patient care networks. However, integrated palliative care for cancer is not common practice. This project, therefore, aims to understand how integrated palliative care and cancer care works in different healthcare settings (inpatient/outpatient), and for which groups of people (at what stage of the cancer journey), so we can develop guidance for optimal delivery.

Methods And Analysis: We will conduct a realist synthesis to develop a programme theory of how integrated palliative care in cancer works, for whom and in what contexts to achieve improved symptom management and quality of life for patients and their families.This realist synthesis will follow the five stages outlined by Pawson: (1) locating existing theories, (2) searching for evidence, (3) article selection, (4) extracting and organising data and (5) synthesising the evidence and drawing conclusions. We will work closely with our expert stakeholder group, which includes health and social care professionals providing palliative care and oncology; management and policy groups and members of the public and patients. We will adhere to RAMESES quality standards for undertaking a realist synthesis.

Ethics And Dissemination: Ethics approval for this project is not required.The realist synthesis will develop a programme theory that provides clarity on the optimal delivery of palliative care for adults with cancer. We will use the programme theory to coproduce guidance and user-friendly outputs, working with stakeholders to inform delivery of best practice. Findings will inform further research in integrated palliative care and cancer. Stakeholder engagement will assist in the dissemination of our findings.

Prospero Registration Number: CRD42023389791.

References

Hui D, Kim Y, Park J, Zhang Y, Strasser F, Cherny N . Integration of oncology and palliative care: a systematic review. Oncologist. 2014; 20(1):77-83. PMC: 4294615. DOI: 10.1634/theoncologist.2014-0312. View

Hjermstad M, Aass N, Andersen S, Brunelli C, Dajani O, Garresori H . PALLiON - PALLiative care Integrated in ONcology: study protocol for a Norwegian national cluster-randomized control trial with a complex intervention of early integration of palliative care. Trials. 2020; 21(1):303. PMC: 7118863. DOI: 10.1186/s13063-020-4224-4. View

Ahmedzai S, Walsh D . Palliative medicine and modern cancer care. Semin Oncol. 2000; 27(1):1-6. View

Bakitas M, Tosteson T, Li Z, Lyons K, Hull J, Li Z . Early Versus Delayed Initiation of Concurrent Palliative Oncology Care: Patient Outcomes in the ENABLE III Randomized Controlled Trial. J Clin Oncol. 2015; 33(13):1438-45. PMC: 4404422. DOI: 10.1200/JCO.2014.58.6362. View

Payne S, Harding A, Williams T, Ling J, Ostgathe C . Revised recommendations on standards and norms for palliative care in Europe from the European Association for Palliative Care (EAPC): A Delphi study. Palliat Med. 2022; 36(4):680-697. PMC: 9006395. DOI: 10.1177/02692163221074547. View

Kaasa S, Loge J, Aapro M, Albreht T, Anderson R, Bruera E . Integration of oncology and palliative care: a Lancet Oncology Commission. Lancet Oncol. 2018; 19(11):e588-e653. DOI: 10.1016/S1470-2045(18)30415-7. View

Dionne-Odom J, Kono A, Frost J, Jackson L, Ellis D, Ahmed A . Translating and testing the ENABLE: CHF-PC concurrent palliative care model for older adults with heart failure and their family caregivers. J Palliat Med. 2014; 17(9):995-1004. PMC: 4158985. DOI: 10.1089/jpm.2013.0680. View

Temel J, Greer J, Muzikansky A, Gallagher E, Admane S, Jackson V . Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010; 363(8):733-42. DOI: 10.1056/NEJMoa1000678. View

Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A . Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014; 383(9930):1721-30. DOI: 10.1016/S0140-6736(13)62416-2. View

10.

Pivodic L, Harding R, Calanzani N, McCrone P, Hall S, Deliens L . Home care by general practitioners for cancer patients in the last 3 months of life: An epidemiological study of quality and associated factors. Palliat Med. 2015; 30(1):64-74. PMC: 4681160. DOI: 10.1177/0269216315589213. View

11.

Wong G, Greenhalgh T, Westhorp G, Buckingham J, Pawson R . RAMESES publication standards: realist syntheses. BMC Med. 2013; 11:21. PMC: 3558331. DOI: 10.1186/1741-7015-11-21. View

12.

Haun M, Estel S, Rucker G, Friederich H, Villalobos M, Thomas M . Early palliative care for adults with advanced cancer. Cochrane Database Syst Rev. 2017; 6:CD011129. PMC: 6481832. DOI: 10.1002/14651858.CD011129.pub2. View

13.

Gomes B, Calanzani N, Curiale V, McCrone P, Higginson I . Effectiveness and cost-effectiveness of home palliative care services for adults with advanced illness and their caregivers. Cochrane Database Syst Rev. 2013; (6):CD007760. PMC: 4473359. DOI: 10.1002/14651858.CD007760.pub2. View

14.

McConnell T, Burden J, Duddy C, Hill L, Howie C, Jones B . Integrating palliative care and heart failure: a protocol for a realist synthesis (PalliatHeartSynthesis). BMJ Open. 2022; 12(1):e058848. PMC: 8744113. DOI: 10.1136/bmjopen-2021-058848. View

15.

Pawson R, Greenhalgh T, Harvey G, Walshe K . Realist review--a new method of systematic review designed for complex policy interventions. J Health Serv Res Policy. 2005; 10 Suppl 1:21-34. DOI: 10.1258/1355819054308530. View

16.

Batra A, Yang L, Boyne D, Harper A, Cuthbert C, Cheung W . Symptom burden in patients with common cancers near end-of-life and its associations with clinical characteristics: a real-world study. Support Care Cancer. 2020; 29(6):3299-3309. DOI: 10.1007/s00520-020-05827-w. View

17.

Hassankhani H, Rahmani A, Taleghani F, Sanaat Z, Dehghannezhad J . Palliative Care Models for Cancer Patients: Learning for Planning in Nursing (Review). J Cancer Educ. 2019; 35(1):3-13. DOI: 10.1007/s13187-019-01532-3. View

18.

Bakitas M, Lyons K, Hegel M, Balan S, Brokaw F, Seville J . Effects of a palliative care intervention on clinical outcomes in patients with advanced cancer: the Project ENABLE II randomized controlled trial. JAMA. 2009; 302(7):741-9. PMC: 3657724. DOI: 10.1001/jama.2009.1198. View