Table 2 Recommendations arising from this review

Section 1: Understanding what needs to be done

Education providers and regulatory bodies

For example: universities, medical schools, nursing colleges, allied health professional training programmes, Royal Colleges, other organisations overseeing continuous professional development, General Medical Council, Nursing and Midwifery Council, and other healthcare regulators.

Integrate palliative care training and experiential learning within the education curriculum and professional development for health and social care professionals.

Funders/commissioners

For example: government departments, Health and Social Care Boards, Integrated Care Boards (ICBs).

Provide appropriate funding routes and resources to facilitate integrated education opportunities.

Researchers and knowledge mobilisers

For example: academic researchers and institutions, public health research agencies, research funders (such as National Institute for Health Research, The Health Foundation).

Encourage organisation and/or system leaders to become more aware of the benefits of integrating palliative care, for example by providing evidence of high-value care/return-on-investment. 

Organisation and system leadership

For example: NHS leadership and executives, Integrated Care System leads, directors or leads of oncology/cancer care.

Take actions that promote the integration of palliative care by considering how funding and incentives, personnel, physical space, performance indicators, and training could be aligned to prioritise integration.

Organisation and professional leaders

For example: national health organisations and professional bodies such as Royal College of General Practitioners, Royal Pharmaceutical College, Allied Health Professions Federation.

Provide clarity on professional responsibilities for palliative care, especially detailing the role of non-specialists, for example by developing guidelines and supporting the implementation of these guidelines across different care settings.

Public health agencies

For example: public health organisations and devolved public health departments, government health ministries, relevant communication partnerships.

Research and invest in public health and mass media campaigns to achieve widespread understanding amongst the public of the benefits of integration of palliative care for patients and their families (i.e., “what’s in it for you and your family”).

Section 2: Involving people in the work

Organisation/system leaders and managers

For example: NHS leadership and executives, Integrated Care System leads, directors or leads of oncology/cancer care.

Identify and support key individuals who act as champions for integration of palliative care, at different levels of seniority, and in different disciplines/professional groups, including forward planning in case of staff turnover.

Organisation/system leaders and managers

For example: NHS leadership and executives, Integrated Care System leads, directors or leads of oncology/cancer care.

Plan information and involvement strategies to actively seek out, understand, and address any concerns of healthcare professionals involved and to identify outcomes that would be most meaningful to them.

Organisation/system leaders and managers

For example: NHS leadership and executives, Integrated Care System leads, directors or leads of oncology/cancer care.

Collaborate with oncology and palliative care professionals to introduce and evaluate approaches to identify palliative care needs more consistently and across different care settings.

Education providers and regulatory bodies

For example: universities, medical schools, nursing colleges, allied health professional training programmes, Royal Colleges, other organisations overseeing continuous professional development, General Medical Council, Nursing and Midwifery Council, and other healthcare regulators.

Provide and endorse training that enables (all) healthcare professionals to be knowledgeable and confident in explaining the goals of palliative care to patients and families.

Section 3: Working together and becoming a team

Organisation/system leaders and managers

For example: NHS leadership and executives, Integrated Care System leads, directors or leads of oncology/cancer care.

Ensure appropriate systems, scheduling, and accountability are in place that enable healthcare professionals to have effective communication (two-way, respectful discussions) about person-centred care. This could include a code of conduct for communication across care settings, as a core responsibility.

Organisation leaders, managers, and team/service leads

For example: NHS leaders, directors of oncology/cancer care, clinical service managers, senior clinicians and healthcare professionals.

Encourage a collaborative working environment within a team culture of respect, understanding, and communication. This could include education or professional development initiatives towards collaboration and advocacy on behalf of the patient.

Commissioners and leadership across different care settings

Including: acute trusts, primary care, community care, third sector providers.

Develop and resource a process that enables coordination of patient care. For example, supporting a named person or team of people with the necessary skills, credibility and influence to take the lead in coordinating care.

Healthcare professionals

For example: multidisciplinary professionals within oncology teams, palliative care teams, primary care, care navigators.

Actively seek to understand and meet the changing informational needs of patients and carers. This includes ensuring that they are made familiar with community services and routes to further support available to them, ideally prior to a crisis occurring.

Healthcare system information providers

For example: equality departments within hospitals, acute trusts, or integrated care systems, and charity information hubs (such as Macmillan, Marie Curie).

Develop informational resources for people with cancer and their families, tailoring for different needs, including levels of health literacy and for disadvantaged groups.

Healthcare professionals

For example: primary care (General Practitioners, nurses, pharmacists), social workers, allied health professionals.

Explicitly support the needs of carers, including sensitive education and honest guidance on what to expect.

Funders or commissioners, organisation and system leadership

For example: government departments, Health and Social Care Boards, Integrated Care Boards (ICBs), NHS leadership and executives, Integrated Care System leads, directors or leads of oncology/cancer care.

Invest in community care, including for out-of-hours, such as 24/7 helplines and/or rapid response services.

Healthcare professionals

For example: multidisciplinary professionals within oncology teams, palliative care teams, primary care (General Practitioners, nurses, pharmacists), social workers, allied health professionals.

Recognise that people who live alone or in rural or deprived areas may have additional challenges as patient or carer.

Understand and respond to factors that may prevent or threaten safety at home (e.g. domestic abuse, neglect, addiction, housing instability). 

Section 4: Considering how well it is working

Organisation leaders, managers, and team/service leads

For example: NHS leaders, directors of oncology/cancer care, clinical service managers, senior clinicians and healthcare professionals.

Develop appropriate and meaningful strategies for the evaluation of integrated palliative care and for providing feedback to teams on their progress.

Organisation leaders, managers, and team/service leads

For example: NHS leaders, directors of oncology/cancer care, clinical service managers, senior clinicians and healthcare professionals.

Facilitate and encourage collaboration between specialist palliative care and generalist palliative care providers, including formal training, collaborative meetings, and informal learning-by-doing.

Team/service leads and healthcare professionals

For example: directors of oncology/cancer care, clinical service managers, senior clinicians, multidisciplinary professionals within oncology teams, and palliative care teams.

Provide and encourage opportunities for reflection, peer support, and emotional support between oncology and palliative care team members.

Healthcare professionals

For example: multidisciplinary professionals within oncology teams, palliative care teams, primary care (General Practitioners, nurses, pharmacists), social workers, allied health professionals.

Foster communication and reflection about the person with cancer’s needs, goals and preferences, in relation to the options that are available to them. Where decision-making is routinely informed by communication, collaboration, and reflection on person-centred needs, this helps to achieve high-value care.