title: Integrated palliative care in the Spanish context: a systematic review of the literature.
abstract: BACKGROUND
  Integrated palliative care (IPC) involves bringing together administrative, organisational, clinical and service aspects in order to achieve continuity of care between all actors involved in the care network of patients receiving palliative care (PC) services. The purpose of this study is to identify literature on IPC in the Spanish context, either in cancer or other advanced chronic diseases.
  
  
  METHODS
  Systematic review of the literature about IPC published in Spain between 1995 and 2013. Sources searched included PubMed, Cochrane Library, Cinahl, the national palliative care Journal (Medicina Paliativa), and Google. Evidence on IPC in care models, pathways, guidelines and other relevant documents were searched. Additionally, data were included from expert sources. Elements of IPC were considered based on the definition of IPC and the Emmanuel´s IPC tool. The main inclusion criterion was a comprehensive description of PC integration.
  
  
  RESULTS
  Out of a total of 2,416 titles screened, 49 were included. We found two models describing IPC interventions achieving continuity and appropriateness of care as a result, 12 guidelines or pathways (most of them with a general approach including cancer and non-cancer and showing a theoretical IPC inclusion as measured by Emmanuel's tool) and 35 other significant documents as for their context relevance (17 health strategy documents, 14 analytical studies and 4 descriptive documents). These last documents comprised respectively: regional and national plans with an IPC inclusion evidence, studies focused on IPC into primary care and resource utilisation; and descriptions of fruitful collaboration programmes between PC teams and oncology departments.
  
  
  CONCLUSIONS
  The results show that explications of IPC in the Spanish literature exist, but that there is insufficient evidence of its impact in clinical practice. This review may be of interest for Spanish-speaking countries and for others seeking to know the status of IPC in the literature in their home nations.
authors.affiliation: Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain. egarralda@unav.es.|Instituto de investigación sanitaria de Navarra (IdiSNA), 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.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hasselaar
authors.affiliation: Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain.|Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
authors.forename: José Miguel
authors.initials: JM
authors.lastname: Carrasco
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Karen
authors.initials: K
authors.lastname: Van Beek
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Naouma
authors.initials: N
authors.lastname: Siouta
authors.affiliation: Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
authors.forename: Agnes
authors.initials: A
authors.lastname: Csikos
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Menten
authors.affiliation: Atlantes Research Programme, Institute for Culture and Society, University of Navarra, Campus Universitario, 31009, Pamplona, Navarra, Spain.|Instituto de investigación sanitaria de Navarra (IdiSNA), Pamplona, Navarra, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: Centeno
mesh_terms: D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D006801:Humans; D009369:Neoplasms / Q000628:therapy; D010166:Palliative Care / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D011788:Quality of Life; D013030:Spain; D019452:Terminally Ill
keywords: Guideline; Integration; Model; Palliative Care; Pathway; Spain