Integrated care is an underpinning concept of contemporary health care policy proffered as a strategy to overcome the fragmentations in care encountered by people with complex care needs (Shaw et al. [2011] What is Integrated Care? An Overview of Integrated Care in the NHS). Cancer patients have potential to benefit from such policy, often having needs that extend beyond cancer. This paper seeks to understand how the concept of integrated care is used in the cancer literature. A search of leading databases was conducted for original research relating to integrated care or an integration intervention aiming to improve outcomes of cancer patients, and analysed using textual narrative synthesis. 38 papers were included, each with a focus on improving cancer-specific aspects of care enhancing the capabilities of the cancer multidisciplinary team. Of the eight studies involving integration between the cancer service and other care providers, all focused on utilising the external provider to deliver aspects of cancer care or placed them in a passive role, as survey participant, a recipient of cancer-related clinical information or as the comparator "usual care" arm. Within the cancer literature, integration is predominantly used to describe initiatives to improve cancer-related aspects of care. Less attention is given to integration initiatives that enhance coordination across levels of the healthcare system or service providers.

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Background In 2011, an advanced practice role was introduced to a specialist regional palliative care service to support an expansion of the number of palliative care home medicines reviews. Aim To gain insight into which types of community‐based palliative care patients benefit from medication management services in order to guide local service development. Method Thematic analysis of a case series of medication reviews conducted by the palliative care pharmacist. Results Over a 12‐week period, 15 medication reviews were conducted and analysed. Four patient categories that related to a clinical need and potential to benefit from a medication review were identified: managing a chronic disease as well as cancer; experiencing ongoing generalised symptoms; having existing or anticipated problems with swallowing or digestion; and having a recognised falls risk. Most patients fit into more than one category. Conclusion There is significant opportunity for pharmacists to enhance the quality of life of palliative care patients through improved use of medicines; however, incorporating the existing home medicine review program does not appear to be the most appropriate method for achieving this due to the program design. Delivering best outcomes for palliative care patients requires models of care that support communication and collaboration across the entire healthcare team and facilitate trusting therapeutic relationships between pharmacists and patients. Integration of advanced generalist pharmacists into clinical care teams is a positive step toward improving patient outcomes in palliative care.

BackgroundTimely access to medicines within the community is important for palliative patients where their preferred place of care is the home environment. This is particularly relevant in the terminal phase of a palliative illness. Commonly encountered symptoms in the terminal phase include: pain, dyspnoea, restlessness, noisy breathing and nausea. While existing national guidelines influence the management of symptoms for palliative patients, the range of medicines usually needed within the community setting to treat noncomplex terminal phase symptoms is less than required in a tertiary inpatient palliative care unit.AimTo (1) Analyse a variety of palliative resources to identify the pharmacological management of common symptoms in the terminal phase; and (2) Create an end-of-life Core Medicines List that guides consistent prescribing for noncomplex community palliative patients in the terminal phase.MethodsSeven stakeholders representing all consultant-led palliative services in South Australia discussed the management of five common symptoms observed in the terminal phase of a palliative illness. The selection of the core medicines took into consideration cost, availability in the doctor's bag, access to government subsidies (eg, PBS) and drug properties.ResultsThe five end-of-life core medicines selected for noncomplex community patients are:Clonazepam 1 mg injection;Haloperidol 5 mg/ml injection;Hyoscine butylbromide 20 mg/ml injection;Metoclopramide 10 mg/2 ml injection; andMorphine 10 mg/ml injectionDiscussionThere is some overlap in the symptoms which these medicines control, thus allowing some options despite the restricted list.ConclusionA concise end-of-life core medicines list of five medicines has been developed to guide prescribing by community clinicians.