An evidence-base for the implementation of hospital-based palliative care programs in routine cancer practice: A systematic review

Abstract

Background: Despite global support, there remain gaps in the integration of early palliative care into cancer care. The methods of implementation whereby evidence of benefits of palliative care is translated into practice deserve attention. Aim: To identify implementation frameworks utilised in integrated palliative care in hospital-based oncology services and to describe the associated enablers and barriers to service integration. Design: Systematic review with a narrative synthesis including qualitative, mixed methods, pre-post and quasi experimental designs following the guidance by the Centre for Reviews and Dissemination (PROSPERO registration CRD42021252092). Data sources: Six databases searched in 2021: EMBASE, EMCARE, APA PsycINFO, CINAHL, Cochrane Library and Ovid MEDLINE searched in 2023. Included were qualitative or quantitative studies, in English language, involving adults >18 years, and implementing hospital-based palliative care into cancer care. Critical appraisal tools were used to assess the quality and rigour. Results: Seven of the 16 studies explicitly cited the use of frameworks including those based on RE-AIM, Medical Research Council evaluation of complex interventions and WHO constructs of health service evaluation. Enablers included an existing supportive culture, clear introduction to the programme across services, adequate funding, human resources and identification of advocates. Barriers included a lack of communication with the patients, caregivers, physicians and palliative care team about programme goals, stigma around the term ‘palliative’, a lack of robust training, or awareness of guidelines and undefined staff roles. Conclusions: Implementation science frameworks provide a method to underpin programme development and evaluation as palliative care is integrated within the oncology setting.

Benchmarking palliative care practices in neurooncology: a german perspective

“…Hence, we advocate that the palliative medicine perspective be incorporated into the interdisciplinary tumor board, the principal decision-making entity in Germany. Enhanced participation of palliative care physicians in these multidisciplinary dialogues could lead to more inclusive decision-making processes, as supported by recent research [ 18 , 19 ]. The national divergence in practices across Germany reflects an absence of standardization, warranting further research to determine optimal timings for the involvement of palliative care in neurooncological conditions.…”

Effects of yoga on hypothyroidism: A systematic review

“…The JBI Critical Appraisal Checklists do not employ a rating system, but to facilitate the comparison of methodological quality among studies, they provide an overall rating based on the mean scores of the questions in the checklist [ 12 ]. The cut-off values for the overall rating are defined as follows: M>0.60 = high methodological quality; 0.30≤ M ≤ 0.60 = moderate methodological quality, and M < 0.30 = low methodological quality [ 13 ].…”