title: Integrating Palliative Care Into Comprehensive Cancer Centers: Consensus-Based Development of Best Practice Recommendations.
abstract: International associations admit that specialized palliative care (SPC) is an obvious component of excellent cancer care. Nevertheless, gaps in integration at the international level have been identified. Recommendations for integrating SPC in clinical care, research, and education are needed, which are subject of the present study.
  
  
  
  A Delphi study, with three written Delphi rounds, including a face-to-face-meeting with a multiprofessional expert panel (n = 52) working in SPC in 15 German Comprehensive Cancer Centers (CCCs) funded by the German Cancer Aid was initiated. Initial recommendations are built on evidence-based literature. Consensus was defined in advance with ≥80% agreement based on the question of whether each recommendation was unambiguously formulated, relevant, and realizable for a CCC.
  
  
  
  A total of 38 experts (73.1%) from 15 CCCs performed all three Delphi rounds. Consensus was achieved for 29 of 30 recommendations. High agreement related to having an organizationally and spatially independent palliative care unit (≥6 beds), a mobile multiprofessional SPC team, and cooperation with community-based SPC. Until round 3, an ongoing discussion was registered on hospice volunteers, a chair of palliative care, education in SPC among staff in emergency departments, and integration of SPC in decision-making processes such as tumor boards or consultation hours. Integration of SPC in decision-making processes was not consented by a low-rated feasibility (76.3%) due to staff shortage.
  
  
  
  Recommendations should be considered when developing standards for cancer center of excellence in Germany. Definition and implementation of indicators of integration of SPC in CCCs and evaluation of its effectiveness are current and future challenges.
  
  
  
  General and specialized palliative care (SPC) is an integral part of comprehensive cancer care. However, significant diversity concerning the design of SPC in the German Comprehensive Cancer Center (CCC) Network led to the establishment of consensual best practice recommendations for integration of SPC into the clinical structures, processes, research, and education throughout the CCC network. The recommendations contribute to a greater awareness relating to the strategic direction and development of SPC in CCCs. The access to information about SPC and access to offers regarding SPC shall be facilitated by implementing the recommendations in the course of treatment of patients with cancer.
authors.affiliation: Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany julia.berendt@uk-erlangen.de.
authors.forename: Julia
authors.initials: J
authors.lastname: Berendt
authors.affiliation: Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Stiel
authors.affiliation: Department of Palliative Medicine, University Hospital of Cologne and Centre for Integrated Oncology Cologne/Bonn, Bonn, Germany.
authors.forename: Steffen T
authors.initials: ST
authors.lastname: Simon
authors.affiliation: Interdisciplinary Center for Palliative Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Schmitz
authors.affiliation: Interdisciplinary Center for Palliative Medicine, Comprehensive Cancer Center Mainfranken, University Hospital of Würzburg, Würzburg, Germany.
authors.forename: Birgitt
authors.initials: B
authors.lastname: van Oorschot
authors.affiliation: Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Stachura
authors.affiliation: Department of Palliative Medicine, Friedrich-Alexander-Universität Erlangen-Nürnberg, Comprehensive Cancer Center Erlangen-EMN, University Hospital Erlangen, Erlangen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Ostgathe
mesh_terms: D003191:Comprehensive Health Care; D032921:Consensus; D019033:Delivery of Health Care, Integrated; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000628:therapy*; D010166:Palliative Care
keywords: Cancer center; Consensus; Delphi technique; Integration; Palliative care; Quality indicators