Integration of oncology and palliative care (PC): A systematic review.

13 Background: Both ASCO and ESMO strongly endorse integrating oncology and PC; however, a global consensus on indicators of integration is currently lacking. To better understand what "integration" entails, we conducted a systematic review to identify articles addressing the clinical, education, and administrative indicators of integration. METHODS We searched Ovid MEDLINE and Ovid EMBase between 1948 to 2013 using the search terms "neoplasms", "integration", and "Palliative Care" or "Supportive Care". Two researchers independently reviewed each citation for inclusion, and then extracted the indicators related to integration. The inter-rater agreement was high (kappa=0.96, P<0.001). RESULTS Our initial search identified 411 publications, and 97 were included in the final sample. 58 (60%) were review articles and 31 (32%) were original articles. The number of articles on integration increased significantly between 1991 and 2013 (P<0.001), with 63 (65%) articles published in 2010 or later. Among these articles, 30 (31%), 16 (16%), 15 (15%) and 8 (8%) articles, respectively, discussed the role of outpatient clinics, community care, PC units, and inpatient consultation teams in integration. 53 (55%) articles addressed various processes for integration, including routine symptom screening (N=16), interdisciplinary teams (N=16), guidelines (N=11), referral criteria (N=10), embedded clinics (N=5) and clinical care pathways (N=5). 31 (32%) mentioned "early" involvement of PC, 11 (11%) provided a specific timing, and 24 (25%) discussed referral criteria. 33 (34%) articles addressed educational strategies for integration, such as training programs (N=13), PC rotations (N=3), and continuing medical education (N=4). 14 (14%) articles described research indicators and 21 (22%) on administrative indicators. No articles specifically defined the term "integration" nor discussed standardized outcomes of integration. CONCLUSIONS Integration was a heterogeneously defined concept. Our systematic review highlighted 40 clinical, educational, research and administrative indicators on integration. This study is part of an international effort to further develop refined and widely endorsed criteria for broad application.