Outpatient and Inpatient Structures: What Does It Need to Integrate Palliative Care Services?

Abstract

How to organise comprehensive cancer care from the onset of metastatic disease to the end of life is debated. Arguments exist for full integration of palliative services into general oncology care, and some studies have shown that oncologists having insight and knowledge about palliative care result in improved collaboration and early referral (Kaasa 2013). There is strong evidence underscoring the importance of integrating palliative care across the trajectory of cancer (Shin and Temel 2013; Bakitas et al. 2009; Alt-Epping et al. 2012). Recommendations for such integration have been made by oncological societies, among others, the American Society of Clinical Oncology (Smith et al. 2012), and by authors of comprehensive review articles on this matter (Gaertner et al. 2013; Greer et al. 2013). These include triangular cooperation between cancer specialists, primary care services and specialist palliative care teams; communication, congruity and continuity of care; and coordination, cooperation contracts and collegiality. A qualitative study among oncologists showed that they believed that integrating palliative care enhanced patient care, complemented their own practice and enabled them to ‘share the load’ (Bakitas et al. 2013).