title: Early integration of palliative care in hospitals: A systematic review on methods, barriers, and outcome.
abstract: OBJECTIVE
  According to the World Health Organization (WHO), palliative care (PC) should be available to everyone suffering from life-threatening diseases and should be started early on in the illness trajectory. However, PC is often initiated much later and is restricted to cancer patients. There is a need for more knowledge about how early PC can be implemented in clinical practice. The purpose of our study was to document the best evidence on methods for early identification (EI) of palliative trajectories in cancer, chronic heart failure (CHF), and chronic obstructive pulmonary disease (COPD) populations, and to identify preconditions for early integration of general PC in hospitals and outcomes for patients and relatives.
  
  
  METHODS
  A comprehensive systematic review of methods, preconditions, and outcomes was conducted via an electronic literature search of publications between 2002 and September 2012. A final sample of 44 papers was reviewed in detail.
  
  
  RESULTS
  Our study identified disease-specific and general methods for EI of patients who might benefit from PC. Prognostication of end-stage disease based on (holistic) clinical judgment, prognostic factors, and/or care needs are the most frequently recommended methods. A number of interacting disease-, staff-, user-, and organization-specific barriers need to be overcome in order to implement early integration of PC in clinical practice. Early integration of PC may lead to better symptom management, prolonged survival, and better quality of life.
  
  
  CONCLUSIONS
  No methods can be recommended for routine clinical practice without further validation. There is an urgent need to develop and evaluate methods based on the holistic assessment of symptoms or needs. The barriers to early integration of PC are most extensive with regard to CHF and COPD. Professional training and education are recommended to facilitate early implementation of PC. The evidence about outcome is sparse and mostly relates to cancer populations receiving specialized PC.
authors.affiliation: The Danish Knowledge Centre for Palliative Care,University of Southern Denmark,Copenhagen,Denmark.
authors.forename: Karen Marie
authors.initials: KM
authors.lastname: Dalgaard
authors.affiliation: The Regional Research Unit, Region Zealand, Roskilde,Koege and Holbaek Hospitals,Denmark.
authors.forename: Heidi
authors.initials: H
authors.lastname: Bergenholtz
authors.affiliation: The Danish Knowledge Centre for Palliative Care,University of Southern Denmark,Copenhagen,Denmark.
authors.forename: Marianne Espenhain
authors.initials: ME
authors.lastname: Nielsen
authors.affiliation: The Danish Knowledge Centre for Palliative Care,University of Southern Denmark,Copenhagen,Denmark.
authors.forename: Helle
authors.initials: H
authors.lastname: Timm
mesh_terms: D061345:Early Medical Intervention / Q000379:methods / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand; D006333:Heart Failure / Q000628:therapy; D006761:Hospitals / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000379:methods*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy
keywords: CHF; COPD; Cancer; Early palliative care; Hospitals