title: Standardizing integration of palliative care into comprehensive cancer therapy--a disease specific approach.
abstract: BACKGROUND
  Our comprehensive cancer centre adopted the WHO recommendation literally in the cancer care guidelines to implement the early integration (EI) of palliative care (PC). Evaluation of the first 2 years of this approach revealed that this guideline was too vague to trigger EI.
  
  
  OBJECTIVE
  As a consequence, an interdisciplinary working group was set up to propose and implement a more effective concept.
  
  
  METHODS
  An interdisciplinary (PC, oncology, radiotherapy, etc.) working group identified the need to (a) specify the timing of EI and (b) specify PC assignments by (c) providing more clear cut semantic and clinical definitions. As a result of repeated discussion in the different interdisciplinary working groups in charge of developing and consenting a once-yearly update of treatment guidelines [standard operating procedure (SOP)] for each malignancy, the need for disease-specific EI SOPs was identified.
  
  
  RESULTS
  SOPs were developed for 19 malignancies (a) to identify a disease-specific point in each disease trajectory to initiate EI ("green flags") and to provide (b) a clear delineation and semantic differentiation of PC assignments ["palliative care" vs. "supportive" or "palliative therapies" ("green" vs. "red flags")].
  
  
  CONCLUSIONS
  To date, ASCO and WHO recommendations for EI lack detailed information about timing and infrastructure. The guidelines presented here aim to provide the missing information by reporting our developed and consented interdisciplinary guidelines for EI.
  
  
  CONCLUSIONS
  With this concept, the authors provide a framework for realizing EI and hope to initiate a discussion about specific recommendations for EI.
authors: Department of Palliative Medicine, University Hospital of Cologne, 50924, Cologne, Germany. jan.gaertner@uk-koeln.de
authors: Jan
authors: J
authors: Gaertner
authors: Juergen
authors: J
authors: Wolf
authors: Michael
authors: M
authors: Hallek
authors: Jan-Peter
authors: JP
authors: Glossmann
authors: Raymond
authors: R
authors: Voltz
mesh_terms: D001601:Bereavement; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006291:Health Policy; D006801:Humans; D009369:Neoplasms / Q000523:psychology*; D010166:Palliative Care / Q000379:methods / Q000458:organization & administration* / Q000523:psychology; D010348:Patient Care Team; D011379:Prognosis; D015397:Program Evaluation; D013997:Time Factors; D014944:World Health Organization