• Massimo Costantini, Giovanni Apolone, Silvia Tanzi, Francesco Falco, Ermanno Rondini, Monica Guberti, Silvia Fanello, Silvio Cavuto, Luisa Savoldi, Roberto Piro, Daniela Mecugni, and Di Leo Silvia S 9 Psycho-Oncology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy..
• 1 Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
• Palliat Med. 2018 Jan 1; 32 (1): 46-58.

BackgroundThere is evidence that early integration of palliative care improves quality of life, lowers spending and helps clarify preferences and goals for advanced cancer patients. Little is known about the feasibility and acceptability of early integration.AimAssessing feasibility of early integration of palliative care, and exploring concerns perceived and problems encountered by patients, relatives and oncologists.DesignA phase 2 mixed-methods study ( ClinicalTrials.Gov :NCT02078700).MethodsOncologists of two outpatient clinics offered a specialised palliative care intervention integrated with standard oncological care to all consecutive newly diagnosed metastatic respiratory/gastrointestinal cancer patients. We interviewed samples of patients, relatives and oncologists to explore strengths and weaknesses of the intervention.ResultsThe intervention was proposed to 44/54 eligible patients (81.5%), 40 (90.1%) accepted, 38 (95.0%) attended the first palliative care visit. The intervention was completed for 32 patients (80.0%). It did not start for three (7.5%) and was interrupted for three patients who refused (7.5%). The Palliative Care Unit performed 274 visits in 38 patients (median per patient 4.5), and 24 family meetings with relatives of 16 patients. All patients and most relatives referred to the usefulness of the intervention, specifically for symptoms management, information and support to strategies for coping. Oncologists highlighted their difficulties in informing patients on palliative intervention, sharing information and coordinating patient's care with the palliative care team.ConclusionEarly integration of palliative care in oncological setting seems feasible and well accepted by patients, relatives and, to a lesser extent, oncologists. Some difficulties emerged concerning patient information and inter-professional communication.

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