title: Indicators of integration of oncology and palliative care programs: an international consensus.
abstract: BACKGROUND
  Recently, the concept of integrating oncology and palliative care has gained wide professional and scientific support; however, a global consensus on what constitutes integration is unavailable. We conducted a Delphi Survey to develop a consensus list of indicators on integration of specialty palliative care and oncology programs for advanced cancer patients in hospitals with ≥100 beds.
  
  
  METHODS
  International experts on integration rated a list of indicators on integration over three iterative rounds under five categories: clinical structure, processes, outcomes, education, and research. Consensus was defined a priori by an agreement of ≥70%. Major criteria (i.e. most relevant and important indicators) were subsequently identified.
  
  
  RESULTS
  Among 47 experts surveyed, 46 (98%), 45 (96%), and 45 (96%) responded over the three rounds. Nineteen (40%) were female, 24 (51%) were from North America, and 14 (30%) were from Europe. Sixteen (34%), 7 (15%), and 25 (53%) practiced palliative care, oncology, and both specialties, respectively. After three rounds of deliberation, the panelists reached consensus on 13 major and 30 minor indicators. Major indicators included two related to structure (consensus 95%-98%), four on processes (88%-98%), three on outcomes (88%-91%), and four on education (93%-100%). The major indicators were considered to be clearly stated (9.8/10), objective (9.4/10), amenable to accurate coding (9.5/10), and applicable to their own countries (9.4/10).
  
  
  CONCLUSIONS
  Our international experts reached broad consensus on a list of indicators of integration, which may be used to identify centers with a high level of integration, and facilitate benchmarking, quality improvement, and research.
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA. Electronic address: dhui@mdanderson.org.
authors.forename: D
authors.initials: D
authors.lastname: Hui
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: S
authors.initials: S
authors.lastname: Bansal
authors.affiliation: Oncological Palliative Medicine, Hematology-Oncology, Cantonal Hospital, St. Gallen, Switzerland.
authors.forename: F
authors.initials: F
authors.lastname: Strasser
authors.affiliation: Department of Palliative and Supportive Care and Seirei Hospice, Seirei Mikatahara General Hospital, Hamamatsu, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Morita
authors.affiliation: Palliative Care, Pain Therapy and Rehabilitation, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Caraceni
authors.affiliation: Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland, USA.
authors.forename: M
authors.initials: M
authors.lastname: Davis
authors.affiliation: Cancer Pain and Palliative Medicine Service, Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel.
authors.forename: N
authors.initials: N
authors.lastname: Cherny
authors.affiliation: European Palliative Care Research Centre, Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology and The Cancer Clinic, St. Olavs Hospital - Trondheim University Hospital, Trondheim, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Kaasa
authors.affiliation: Palliative and Supportive Services, Flinders University, Adelaide, South Australia.
authors.forename: D
authors.initials: D
authors.lastname: Currow
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, USA.
authors.forename: A
authors.initials: A
authors.lastname: Abernethy
authors.affiliation: Division of Palliative Care Medicine, Department of Oncology, University of Alberta, Edmonton, Canada.
authors.forename: C
authors.initials: C
authors.lastname: Nekolaichuk
authors.affiliation: Department of Palliative Care and Rehabilitation Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA.
authors.forename: E
authors.initials: E
authors.lastname: Bruera
mesh_terms: D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000379:methods*; D005104:Expert Testimony / Q000379:methods*; D005260:Female; D006282:Health Personnel; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011795:Surveys and Questionnaires; D018511:Systems Integration
keywords: access; health systems; indicators; integration; neoplasms; palliative care