PAL-CYCLES

The key objective of the project is to develop, implement and evaluate a novel transitional palliative cancer care programme for patients with cancer, with an intervention that aims for a smooth transition from the hospital to community-based care in the final months of life.

Many patients with advanced cancer in the final phase of life leave the hospital without continuity of information, and certainty about further treatment and care provision. Often, communication between healthcare providers in different settings is suboptimal and this leads to poor continuity and coordination of care, negatively impacting the quality of life of the patient and increasing preventable hospital admissions in the final phase of life.

The Solution is the PAL-CYCLES programme: a transitional palliative care programme for patients with advanced cancer, adaptable to local cultures and healthcare systems. The programme contains an intervention consisting of five cornerstone components:

(1) identification at discharge of a patient with palliative and supportive care needs in collaboration with the oncologist and the hospital palliative care team;

(2) compassionate communication towards the patient and their family; (3) collaborative effort to establish a multidimensional treatment plan and follow-up in the home care setting;

(4) periodic discussion and evaluation of the treatment plan with patients and relatives, led by the GP, oncologist or palliative care team, depending on patient place of stay, care needs, and local possibilities;

(5) identification of the terminal phase (if there) based on the periodic evaluations, with appropriate intensification of treatment and end-oflife talks, including consultation with patient and families about ethically and legally sensitive issues like withdrawal of treatment, preferred place of death, rituals in the last phase of life, etc., depending on local possibilities and habits.

The project intends to develop, adapt, implement, and evaluate the PAL-CYCLES programme in seven European countries using a stepped wedge randomized controlled trial design. Patient, relatives, and health care provider experiences, as well as ethical and equity issues will be addressed with qualitative methods.