title: Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease.
abstract: BACKGROUND
  Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. Further, develop a generic framework that will consist of the basis for the design of future models for integrated PC in Europe.
  
  
  METHODS
  Cochrane, PubMed, EMBASE, CINAHL, AMED, BNI, Web of Science, NHS Evidence. Five journals and references from included studies were hand-searched. Two reviewers screened the search results. Studies with adult patients with advanced cancer/chronic disease from 1995 to 2013 in Europe, in English, French, German, Dutch, Hungarian or Spanish were included. A narrative synthesis was used.
  
  
  RESULTS
  14 studies were included, 7 models for chronic disease, 4 for integrated care in oncology, 2 for both cancer and chronic disease and 2 for end-of-life pathways. The results show a strong agreement on the benefits of the involvement of a PC multidisciplinary team: better symptom control, less caregiver burden, improvement in continuity and coordination of care, fewer admissions, cost effectiveness and patients dying in their preferred place.
  
  
  CONCLUSIONS
  Based on our findings, a generic framework for integrated PC in cancer and chronic disease is proposed. This framework fosters integration of PC in the disease trajectory concurrently with treatment and identifies the importance of employing a PC-trained multidisciplinary team with a threefold focus: treatment, consulting and training.
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium. naouma.siouta@gmail.com.
authors.forename: Naouma
authors.initials: N
authors.lastname: Siouta
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: K
authors.initials: K
authors.lastname: Van Beek
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M E
authors.initials: ME
authors.lastname: van der Eerden
authors.affiliation: International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
authors.forename: N
authors.initials: N
authors.lastname: Preston
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: J G
authors.initials: JG
authors.lastname: Hasselaar
authors.affiliation: International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
authors.forename: S
authors.initials: S
authors.lastname: Hughes
authors.affiliation: Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
authors.forename: E
authors.initials: E
authors.lastname: Garralda
authors.affiliation: Department of Palliative Medicine, University of Navarra Hospital, Pamplona, Navarra, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Centeno
authors.affiliation: Faculty of Medicine, Institute of Family Medicine, University of Pécs Medical School, Pécs, Hungary.
authors.forename: A
authors.initials: A
authors.lastname: Csikos
authors.affiliation: Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Groot
authors.affiliation: Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
authors.forename: L
authors.initials: L
authors.lastname: Radbruch
authors.affiliation: International Observatory on End of Life Care, Division of Health Research, Lancaster University, Lancaster, UK.
authors.forename: S
authors.initials: S
authors.lastname: Payne
authors.affiliation: Department of Radiation-Oncology and Palliative Medicine, University Hospital Gasthuisberg, Herestraat 49, 3000, Leuven, Belgium.
authors.forename: J
authors.initials: J
authors.lastname: Menten
mesh_terms: D000328:Adult; D002908:Chronic Disease / Q000628:therapy*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D005060:Europe; D006801:Humans; D007400:Interprofessional Relations; D008962:Models, Theoretical; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care / Q000458:organization & administration*; D010348:Patient Care Team / Q000458:organization & administration
keywords: Chronic disease; Delivery of health care; Integrated; Medical oncology; Palliative care; Review; Systematic