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• W2260503332 abstract "We would like to thank Verna et al. [1.Verna L. Giusti R. Marchetti P. et al.Integration between oncology and palliative care: does one size fit all?.Ann Oncol. 2015; (pii: mdv582)PubMed Google Scholar] for their thoughtful comments regarding our recent Annals of Oncology article on the 13 major and 30 minor indictors of integration of oncology and palliative care programs in hospitals with ≥100 beds [2.Hui D. Bansal S. Strasser F. et al.Indicators of integration of oncology and palliative Care programs: an international consensus.Ann Oncol. 2015; 26: 1953-1959Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar]. They commented on the need to have indicators specific for resource-limited settings, and the importance of community-based palliative care programs. When we first designed this study, we recognized that indicators are highly specific to the health care setting and local resources. Thus, we explicitly asked our panelists to identify indictors of integration for advanced cancer patients in hospitals with ≥100 beds [2.Hui D. Bansal S. Strasser F. et al.Indicators of integration of oncology and palliative Care programs: an international consensus.Ann Oncol. 2015; 26: 1953-1959Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar]. Remarkably, a vast majority of the indicators were supported by our international panelists despite their diverse background representing six continents. The major indicators were endorsed by over 90% of panelists, suggesting that there may be some universal themes of integration beyond nationalities, disciplines and cultures. The need for integration is independent of resource availability and further studies are needed to examine indicators of integration specific for low-resource settings. In a recent systematic review, we identified several other aspects of integration [3.Hui D. Kim Y.J. Park J.C. et al.Integration of oncology and palliative care: a systematic review.Oncologist. 2015; 20: 77-83Crossref PubMed Scopus (106) Google Scholar]. For example, the availability of opioid may be an appropriate indicator in low-resource countries, while a comprehensive home palliative care program may not be possible. On the one hand, integration may be accomplished without a significant investment of resources, such as mandating clinical palliative care rotations for oncology fellows. On the other hand, if the resources are so limited that the basic palliative care infrastructure is lacking, it may be difficult to consider the programs integrated. Ultimately, experts from resource-limited countries need to refine the appropriate indicators for their own settings. There is also a fine distinction between indicators for integration and indicators for program development. While others have examined indicators for palliative care development [4.Centeno C. Clark D. Lynch T. et al.Facts and indicators on palliative care development in 52 countries of the WHO European region: results of an EAPC Task Force.Palliat Med. 2007; 21: 463-471Crossref PubMed Scopus (112) Google Scholar, 5.Pastrana T. Torres-Vigil I. De Lima L. Palliative care development in Latin America: an analysis using macro indicators.Palliat Med. 2014; 28: 1231-1238Crossref PubMed Scopus (45) Google Scholar], our study is the first to focus on assessing the level of integration [2.Hui D. Bansal S. Strasser F. et al.Indicators of integration of oncology and palliative Care programs: an international consensus.Ann Oncol. 2015; 26: 1953-1959Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar]. Clearly, home-based palliative care programs offer tremendous benefits for patients in the community, and is particularly indispensable in the last few months and weeks of life [6.Davis M.P. Temel J.S. Balboni T. Glare P. A review of the trials which examine early integration of outpatient and home palliative care for patients with serious illnesses.Ann Palliat Med. 2015; 4: 99-121PubMed Google Scholar]; however, only approximately half of our experts endorsed that such programs as an indicator of integration [2.Hui D. Bansal S. Strasser F. et al.Indicators of integration of oncology and palliative Care programs: an international consensus.Ann Oncol. 2015; 26: 1953-1959Abstract Full Text Full Text PDF PubMed Scopus (86) Google Scholar]. This may be because ‘early’ integration occurs predominantly in the ambulatory setting. Instead of operating such community programs, integration means that hospitals closely coordinate with them. To rephrase the words of the newly elected Canadian Prime Minister Justin Trudeau, ‘A positive, optimistic, hopeful vision of (integration) isn't a naïve dream—it can be a powerful force for change’. Our indicators set some important goals towards delivery of integrated cancer care. Although a majority of the major indicators are likely universal across many health care settings (e.g. outpatient clinics, interdisciplinary teams and early referral), some minor indicators need to be tailored to local realities and the unique cultural needs (e.g. prognostic discussions). Moving forward, more research is needed to ‘personalize’ the indicators of integration in different health care settings, to fine tune the thresholds, and to validate them against meaningful patient- and caregiver-related outcomes. The authors have declared no conflicts of interest." @default.
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• W2260503332 title "Reply to the letter to the editor ‘Integration between oncology and palliative care: does one size fit all?’ by Verna et al." @default.
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