Type of initiative | Guideline: Guidelines are systematically developed statements to assist practitioners and patient decisions about appropriate healthcare for specific clinical circumstances | Pathway: A care pathway is a complex intervention for the mutual decision-making and organisation of care processes for a well-defined group of patients during a well-defined period. A pathway may use guidelines to provide clinical care | Model: Description of a ‘model’ or ‘pilot’ project of integrated palliative care (IPC) in a defined setting (eg, hospital, nursing home, home, palliative care (PC) team) | – |
Level of care | Primary: General practitioner (GP), nursing service, community care | Secondary: Specialist physicians, specialist nursing services, hospitals, inpatient hospices | Tertiary: Academic training centres, comprehensive cancer centres | – |
Sector | Inpatient/institution centred: PC for patients is focused on an institution-based setting, ie, in-hospitals, hospices or outpatient clinics, and is not continued outside these institutions (even when the condition of the patient deteriorates) | Homecare: PC provided at the place where patients permanently live, that is, in their homes, residential homes or nursing homes | – | – |
Time frame of intervention | Early integration: PC needs are identified at an early stage/PC starts from the time of diagnosis | Concurrent: PC becomes integrated in the course of advanced disease and lasts till the patient’s death | End of life: PC sets in the final stage of the disease | – |
Focus of intervention | Treating function: PC specialists’ main focus is directed at the treatment of patients | Advising/consulting: PC specialists’ main focus is directed at the consultation of patients and their relatives (family caregivers) | Training: PC specialists’ main focus is directed at the education of professionals and family caregivers involved in the IPC process | – |
Collaboration and communication strategy | Network: There is a network of PC expertise available, that knows each other well and is easily accessible for PC caregivers and any other health-related profession | Protocol: Standardised referrals and treatments plans are in place to coordinate care | Team: Caregivers are part of a single team (for specific patients) focusing on a single treatment plan with regular meetings. This team may be hospital based or community based | Case management: A case manager is primarily responsible for involving all relevant caregivers and coordination of care for specific patients. Case management can also be hospital based or community based |
Key contact | Non-pc specialist: The treatment of patients is coordinated by professionals without a specialisation in PC (excluding GPs) | Pc-specialist: The treatment of patients is coordinated by professionals with a specialisation in PC (eg, a nurse specialised in PC; excluding GPs) | GPs: The treatment of patients is coordinated by GPs (including those with specialisation in palliative care) | – |