Integrated Palliative Care: Clinical, Organizational, and Health System Perspectives

  • Jeroen HasselaarEmail author
  • Agnes Csikos
  • Carlos Centeno
  • Sheila Payne
Reference work entry


This chapter explores current literature and initiatives in the field of integrated palliative care. The chapter starts with an exploration of the concept of integrated palliative care, followed by practice examples across Europe, models from the literature, and examples from guidelines. After this, barriers and opportunities for integrated palliative care are investigated. Finally, proceedings from the World Health Organization are highlighted to picture an international perspective. We conclude that integrated care has often been considered and discussed from the perspective of better integrated healthcare delivery, which is needed and valuable. But efforts for better integration of palliative care should move beyond a better organization of medical care and need to be rigorously designed from the perspective of the suffering patient in the last phase of life, and their families.


  1. Bakitas MA, Tosteson TD, Li Z, Lyons KD, Hull JG, Li Z, Dionne-Odom JN, Frost J, Dragnev KH, Hegel MT, Azuero A, Ahles TA. Early versus delayed initiation of concurrent palliative oncology care: patient outcomes in the ENABLE III randomized controlled trial. J Clin Oncol. 2015;33(13):1438–45.CrossRefGoogle Scholar
  2. Beernaert K, Smets T, Cohen J, Verhofstede R, Costantini M, Eecloo K, Van Den Noortgate N, Deliens L. Improving comfort around dying in elderly people: a cluster randomised controlled trial. Lancet. 2017;390:125–34.CrossRefGoogle Scholar
  3. Berendt J, Stiel S, Simon ST, Schmitz A, van Oorschot B, Stachura P, Ostgathe C. Integrating palliative care into comprehensive cancer centers: consensus-based development of best practice recommendations. Oncologist. 2016;21(10):1241–9.CrossRefGoogle Scholar
  4. Bone AE, Morgan M, Maddocks M, Sleeman KE, Wright J, Taherzadeh S, Ellis-Smith C, Higginson IJ, Evans CJ. Developing a model of short-term integrated palliative and supportive care for frail older people in community settings: perspectives of older people, carers and other key stakeholders. Age Ageing. 2016;45(6):863–73. Epub 2016 Sep 1.CrossRefGoogle Scholar
  5. Bristowe K, Carey I, Hopper A, Shouls S, Prentice W, Caulkin R, Higginson IJ, Koffman J. Patient and carer experiences of clinical uncertainty and deterioration, in the face of limited reversibility: a comparative observational study of the AMBER care bundle. Palliat Med. 2015;29(9):797–807.CrossRefGoogle Scholar
  6. Bristowe K, Carey I, Hopper A, Shouls S, Prentice W, Higginson IJ, Koffman J. Seeing is believing – healthcare professionals’ perceptions of a complex intervention to improve care towards the end of life: a qualitative interview study. Palliat Med. 2018;32(2):525–532.CrossRefGoogle Scholar
  7. Busetto L, Kiselev J, Luijkx KG, Steinhagen-Thiessen E, Vrijhoef HJ. Implementation of integrated geriatric care at a German hospital: a case study to understand when and why beneficial outcomes can be achieved. BMC Health Serv Res. 2017;17(1):180.CrossRefGoogle Scholar
  8. Carey I, Shouls S, Bristowe K, Morris M, Briant L, Robinson C, Caulkin R, Griffiths M, Clark K, Koffman J, Hopper A. Improving care for patients whose recovery is uncertain. The AMBER care bundle: design and implementation. BMJ Support Palliat Care. 2015;5(1):12–8.CrossRefGoogle Scholar
  9. Centeno C, Garralda E, Carrasco JM, den Herder-van der Eerden M, Aldridge M, Stevenson D, Meier DE, Hasselaar J. The palliative care challenge: analysis of barriers and opportunities to integrate palliative care in Europe in the view of National Associations. J Palliat Med. 2017;20:1195–204.CrossRefGoogle Scholar
  10. Chan RJ, Webster J, Bowers A. End-of-life care pathways for improving outcomes in caring for the dying. Cochrane Database Syst Rev. 2016;2:CD008006.PubMedGoogle Scholar
  11. Clifford C, Thomas K, Armstrong-Wilson J. Going for gold: the golds standards framework programme and accreditation in primary care. End Life J. 2016;6:e000028.Google Scholar
  12. Currow DC, Higginson I. Time for a prospective study to evaluate the Amber Care Bundle. BMJ Support Palliat Care. 2013;3(4):376–7.CrossRefGoogle Scholar
  13. den Herder-van der Eerden M, Hasselaar J, Payne S, Varey S, Schwabe S, Radbruch L, Van Beek K, Menten J, Busa C, Csikos A, Vissers K, Groot M. How continuity of care is experienced within the context of integrated palliative care: a qualitative study with patients and family caregivers in five European countries. Palliat Med. 2017;31:946–55.CrossRefGoogle Scholar
  14. Department of Health, London. More care, less pathway independent report on the Liverpool care pathway. London: Department of Health; 2013.Google Scholar
  15. Edmonds P, Hart S, Gao W, Vivat B, Burman R, Silber E, Higginson IJ. Palliative care for people severely affected by multiple sclerosis: evaluation of a novel palliative care service. Mult Scler. 2010;16(5):627–36.CrossRefGoogle Scholar
  16. Emanuel L, Alexander C, Arnold RM, Bernstein R, Dart R, Dellasantina C, Dykstra L, Tulsky J. Integrating palliative care into disease management guidelines. J Palliat Med. 2004;7(6):774–83.CrossRefGoogle Scholar
  17. Ewert B, Hodiamont F, van Wijngaarden J, Payne S, Groot M, Hasselaar J, Menten J, Radbruch L. Building a taxonomy of integrated palliative care initiatives: results from a focus group. BMJ Support Palliat Care. 2016;6(1):14–20.CrossRefGoogle Scholar
  18. Fadhil I, Lyons G, Payne S. Barriers to, and opportunities for, palliative care development in the Eastern Mediterranean Region. Lancet Oncol. 2017;18(3):e176–84.CrossRefGoogle Scholar
  19. Ferrell BR, Temel JS, Temin S, et al. Integration of palliative care into standard oncology care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol. 2017;35:96–102.CrossRefGoogle Scholar
  20. Gómez-Battiste X, Connor S. Building integrated palliative care programs and services. Catalonia, 2017. University of Vic Eumo Editorial / Chair of Palliative Care / World Hospice and Palliative Care Alliance.
  21. Hasselaar J, Payne S. Integrated palliative care. 2016. Available via
  22. Higginson IJ, McCrone P, Hart SR, Burman R, Silber E, Edmonds PM. Is short-term palliative care cost-effective in multiple sclerosis? A randomized phase II trial. J Pain Symptom Manag. 2009;38(6):816–26.CrossRefGoogle Scholar
  23. Higginson IJ, Bausewein C, Reilly CC, Gao W, Gysels M, Dzingina M, McCrone P, Booth S, Jolley CJ, Moxham J. An integrated palliative and respiratory care service for patients with advanced disease and refractory breathlessness: a randomised controlled trial. Lancet Respir Med. 2014;2(12):979–87.CrossRefGoogle Scholar
  24. Hughes PM, Bath PA, Ahmed N, Noble B. What progress has been made towards implementing national guidance on end of life care? A national survey of UK general practices. Palliat Med. 2010;24(1):68–78.CrossRefGoogle Scholar
  25. Hui D, Bansal S, Strasser F, Morita T, Caraceni A, Davis M, Cherny N, Kaasa S, Currow D, Abernethy A, Nekolaichuk C, Bruera E. Indicators of integration of oncology and palliative care programs: an international consensus. Ann Oncol. 2015;26(9):1953–9.CrossRefGoogle Scholar
  26. Neuberger J (chair). More care, less pathway: a review of the Liverpool care pathway. 2013.Google Scholar
  27. Omega. End of life care in primary care: 2009 national snapshot. 2009.Google Scholar
  28. Radbruch L, Payne S. White paper on standards and norms for hospice and palliative care in Europe: part 1. Eur J Palliat Care. 2010;17:22–33.Google Scholar
  29. Sallnow L, Richardson H, Murray SA, Kellehear A. The impact of a new public health approach to end-of-life care: a systematic review. Palliat Med. 2016;30(3):200–11.CrossRefGoogle Scholar
  30. Siouta N, van Beek K, Preston N, Hasselaar J, Hughes S, Payne S, Garralda E, Centeno C, van der Eerden M, Groot M, Hodiamont F, Radbruch L, Busa C, Csikos A, Menten J. Towards integration of palliative care in patients with chronic heart failure and chronic obstructive pulmonary disease: a systematic literature review of European guidelines and pathways. BMC Palliat Care. 2016a;15:18.CrossRefGoogle Scholar
  31. Siouta N, Van Beek K, van der Eerden ME, Preston N, Hasselaar JG, Hughes S, Garralda E, Centeno C, Csikos A, Groot M, Radbruch L, Payne S, Menten J. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease. BMC Palliat Care. 2016b;15:56.CrossRefGoogle Scholar
  32. Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, Billings JA, Lynch TJ. Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 2010;363(8):733–42.CrossRefGoogle Scholar
  33. Thoonsen B, Vissers K, Verhagen S, Prins J, Bor H, van Weel C, Groot M, Engels Y. Training general practitioners in early identification and anticipatory palliative care planning: a randomized controlled trial. BMC Fam Pract. 2015;16:126.CrossRefGoogle Scholar
  34. Valentijn PP, Schepman SM, Opheij W, Bruijnzeels MA. Understanding integrated care: a comprehensive conceptual framework based on the integrative functions of primary care. Int J Integr Care. 2013;13:e010.CrossRefGoogle Scholar
  35. Van Beek K, Siouta N, Preston N, Hasselaar J, Hughes S, Payne S, Radbruch L, Centeno C, Csikos A, Garralda E, van der Eerden M, Hodiamont F, Radvanyi I, Menten J. To what degree is palliative care integrated in guidelines and pathways for adult cancer patients in Europe: a systematic literature review. BMC Palliat Care. 2016;15:26.CrossRefGoogle Scholar
  36. van der Eerden M, Csikos A, Busa C, Hughes S, Radbruch L, Menten J, Hasselaar J, Groot M. Experiences of patients, family and professional caregivers with Integrated Palliative Care in Europe: protocol for an international, multicenter, prospective, mixed method study. BMC Palliat Care. 2014;13(1):52. Scholar
  37. van der Plas AG, Hagens M, Pasman HR, Schweitzer B, Duijsters M, Onwuteaka-Philipsen BD. PaTz groups for primary palliative care: reinventing cooperation between general practitioners and district nurses in palliative care: an evaluation study combining data from focus groups and a questionnaire. BMC Fam Pract. 2014;15:14.CrossRefGoogle Scholar
  38. van der Steen JT, Radbruch L, Hertogh CM, de Boer ME, Hughes JC, Larkin P, Francke AL, Jünger S, Gove D, Firth P, Koopmans RT, Volicer L, European Association for Palliative Care (EAPC). White paper defining optimal palliative care in older people with dementia: a Delphi study and recommendations from the European Association for Palliative Care. Palliat Med. 2014;28(3):197–209.CrossRefGoogle Scholar
  39. Veerbeek L, van Zuylen L, Swart SJ, van der Maas PJ, de Vogel-Voogt E, van der Rijt CC, van der Heide A. The effect of the Liverpool care pathway for the dying: a multi-centre study. Palliat Med. 2008;22(2):145–51.CrossRefGoogle Scholar
  40. Verna L, Giusti R, Marchetti P, Ficorella C, Porzio G. Integration between oncology and palliative care: does one size fit all? Ann Oncol. 2016;27(3):549.CrossRefGoogle Scholar
  41. World Health Organization. Report on integrated people-centered health services: report by the secretariat. 2016. Accessed Jul 2017.
  42. Yoong J, Park ER, Greer JA, Jackson VA, Gallagher ER, Pirl WF, Back AL, Temel JS. Early palliative care in advanced lung cancer: a qualitative study. JAMA Intern Med. 2013;173(4):283–90.CrossRefGoogle Scholar
  43. Zimmermann C, Swami N, Krzyzanowska M, Hannon B, Leighl N, Oza A, Moore M, Rydall A, Rodin G, Tannock I, Donner A, Lo C. Early palliative care for patients with advanced cancer: a cluster-randomised controlled trial. Lancet. 2014;383(9930):1721–30.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Jeroen Hasselaar
    • 1
    Email author
  • Agnes Csikos
    • 2
  • Carlos Centeno
    • 3
    • 5
  • Sheila Payne
    • 4
  1. 1.Department of Anesthesiology, Pain and Palliative MedicineRadboud University Medical CenterNijmegenThe Netherlands
  2. 2.Department of Primary carePecs UniversityPécsHungary
  3. 3.ATLANTES Research Program, Institute for Culture and SocietyUniversity of NavarraPamplonaSpain
  4. 4.International Observatory on End of Life CareLancaster UniversityLancasterUK
  5. 5.Palliative Care Unit, Clínica Universidad de NavarraUniversity of NavarraPamplonaSpain

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