Abstract
BackgroundIntegrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. Further, develop a generic framework that will consist of the basis for the design of future models for integrated PC in Europe.MethodsCochrane, PubMed, EMBASE, CINAHL, AMED, BNI, Web of Science, NHS Evidence. Five journals and references from included studies were hand-searched. Two reviewers screened the search results. Studies with adult patients with advanced cancer/chronic disease from 1995 to 2013 in Europe, in English, French, German, Dutch, Hungarian or Spanish were included. A narrative synthesis was used.Results14 studies were included, 7 models for chronic disease, 4 for integrated care in oncology, 2 for both cancer and chronic disease and 2 for end-of-life pathways. The results show a strong agreement on the benefits of the involvement of a PC multidisciplinary team: better symptom control, less caregiver burden, improvement in continuity and coordination of care, fewer admissions, cost effectiveness and patients dying in their preferred place.ConclusionBased on our findings, a generic framework for integrated PC in cancer and chronic disease is proposed. This framework fosters integration of PC in the disease trajectory concurrently with treatment and identifies the importance of employing a PC-trained multidisciplinary team with a threefold focus: treatment, consulting and training.
Highlights
Introduction and aimsWas there a good background and clear statement of the aims of the research?Full but concise background to discussion/study containing up-todate literature review and highlighting gaps in knowledge.Clear statement of aim AND objectives including research questions.Some background and literature review.Research questions outlined.Some background but no aim/objectives/questions, OR
Models determine the norms of Palliative Care (PC) practice and offer values and principles that professionals can use as guides and can provide important information for understanding integrated PC practices and evaluating their associated strengths and weaknesses
We reviewed existing literature on evidence-based models for integrated PC in patients with cancer or chronic disease in Europe
Summary
Introduction and aimsWas there a good background and clear statement of the aims of the research?Full but concise background to discussion/study containing up-todate literature review and highlighting gaps in knowledge.Clear statement of aim AND objectives including research questions.Some background and literature review.Research questions outlined.Some background but no aim/objectives/questions, OR. Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. According to the World Health Organization (WHO), Palliative Care (PC) aims to improve the quality of life of patients and families who face life-threatening illness, by providing pain and symptom relief, spiritual and psychosocial support from diagnosis to end of life care and bereavement. There are calls for developing generic PC models that will incorporate recent findings concerning the early identification of patients with needs for PC services and foster the integration of PC early in the care plan and throughout the disease trajectory [9,10,11,12,13,14,15]
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