title: To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review.
abstract: BACKGROUND
  Palliative Care (PC) aims to improve the quality of life for patients with cancer and their families and its benefits have been demonstrated by several studies. The objective of this systematic review is to assess the integration of PC in the content of guidelines/pathways of adult cancer patients in Europe.
  
  
  METHODS
  We included studies of adult patients with cancer published from 01/01/1995 and 31/12/2013 in Europe in six languages. We searched nine electronic databases, hand-searched six journals and also performed citation tracking. Studies were ranked using Emanuel's Integrated Palliative Care (IPC) criteria, a tool containing 11 domains to assess PC content in guidelines. Two reviewers screened the results and narrative synthesis has been employed.
  
  
  RESULTS
  We identified a total of 28,277 potentially relevant articles from which 637 were eligible for full-text screening. The final review included 60 guidelines and 14 pathways. Eighty percent (80%) of the guidelines/pathways emphasize a holistic approach and 66% focus on PC interventions aimed at reducing suffering. Fifty seven percent (57%) did not discuss referral criteria for PC. Of all studies, five fulfilled at least 10/11 IPC criteria. Differences existed with regard to the referral criteria for bereavement care and the continuous adjustment of goals of care.
  
  
  CONCLUSIONS
  Overall, most of the identified guidelines/pathways highlighted the importance of the holistic approach of IPC. The studies that were found to fulfil at least 10/11 Emanuel's IPC criteria could serve as benchmarks of IPC.
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium. karen.vanbeek@uzleuven.be.
authors.forename: Karen
authors.initials: K
authors.lastname: Van Beek
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium. naouma.siouta@ppw.kuleuven.com.
authors.forename: Naouma
authors.initials: N
authors.lastname: Siouta
authors.affiliation: International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom. n.j.preston@lancaster.ac.uk.
authors.forename: Nancy
authors.initials: N
authors.lastname: Preston
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Jeroen.Hasselaar@radboudumc.nl.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hasselaar
authors.affiliation: International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom. sean.hughes@lancaster.ac.uk.
authors.forename: Sean
authors.initials: S
authors.lastname: Hughes
authors.affiliation: International Observatory on End of Life Care, Division of Health Research Lancaster University, Lancaster, United Kingdom. s.a.payne@lancaster.ac.uk.
authors.forename: Sheila
authors.initials: S
authors.lastname: Payne
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany. Lukas.Radbruch@malteser.org.
authors.forename: Lukas
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain. ccenteno@unav.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
authors.affiliation: Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary. agnes.csikoska@gmail.com.
authors.forename: Agnes
authors.initials: A
authors.lastname: Csikos
authors.affiliation: Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain. egarralda@unav.es.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Garralda
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Marlieke.vanderEerden@radboudumc.nl.
authors.forename: Marlieke
authors.initials: M
authors.lastname: van der Eerden
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany. Farina.Hodiamont@med.uni-muenchen.de.
authors.forename: Farina
authors.initials: F
authors.lastname: Hodiamont
authors.affiliation: Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary. csillabusa@gmail.com.
authors.forename: Ildiko
authors.initials: I
authors.lastname: Radvanyi
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium. johan.menten@uzleuven.be.
authors.forename: Johan
authors.initials: J
authors.lastname: Menten
mesh_terms: D000328:Adult; D005060:Europe; D006287:Health Planning Guidelines; D006801:Humans; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000379:methods*; D011788:Quality of Life; D012017:Referral and Consultation