Department of Research & Development, Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, the Netherlands.
Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands.
Support Care Cancer. 2024 May 3;32(5):324. doi: 10.1007/s00520-024-08508-0.
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.
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%.
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%).
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.
从最佳实践中确定将姑息治疗（PC）及时纳入医院肿瘤治疗的要素。此后，评估肿瘤学和 PC 专家以及患者和亲属代表对 PC 及时整合特征的共识程度。
进行了三轮改良 Delphi 研究。专家小组由来自 21 家荷兰医院的 83 名医疗保健专业人员（HCP）组成（43 名医生，40 名护士），6 名患者和 2 名亲属代表。在第一轮中，考虑了综合 PC 的四个要素：（1）确定潜在的 PC 需求，（2）预先护理计划（ACP），（3）常规症状监测和（4）专家姑息治疗团队（SPCT）的参与。在随后的几轮中，小组成员评估了启动要素的特征。事先设定的共识标准为≥70％。
共有 71 名（78％）小组成员完成了第一轮问卷，65 名（71％）完成了第二轮，49 名（54％）完成了第三轮。小组成员一致认为，所有患有不治之症的癌症患者都应评估其 PC 需求（97％），监测症状（91％）并启动 ACP（86％）。应根据患者的要求或当患者在多个维度上出现症状负担增加时，让 SPCT 参与（86％）。预期寿命不足 3 个月的患者应提供咨询（71％）。
专家组一致认为，及时将 PC 纳入肿瘤学对于所有患有不治之症的癌症患者都很重要，使用早期识别，ACP 和常规症状监测。在多维症状负担和接近死亡的患者中，特别需要 SPCT 的参与。
Zotero 插件