Background Despite mature evidence of the benefits of early palliative integration into the care of people with cancer, in Australia, referral to palliative care remains variable and often late, if at all. A series of barriers including uncertainty around timing of referral, fear and stigma of palliative care and variability of access impede translation of this evidence into practice.

Aim To describe the elements of Care Plus, an intervention designed to specifically address the barriers of early palliative care integration with oncology as a standard of care.

Methods Based on the Medical Research Council framework (figure 1) for the development and evaluation of complex interventions, data was collated from: phase 1 qualitative studies exploring patient, family and health professional views of palliative care, as well as statewide health service data mapping patterns of care; phase 2 pilot feasibility trials; and phase 3 randomised controlled trials to inform the Care Plus intervention. The intervention was then introduced as part of an implementation study across 4 hospitals in two Australian states.

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Abstract OP-20 Figure 1

MRC framework process for complex interventions

Results The Care Plus intervention addresses the barriers to early palliative care by multiple strategies; (1) referrals were based on trigger points in the illness established in collaboration with referring clinicians; (2) the name Care Plus was used, and suggested language and training to support referrers to overcome stigma of palliative care; (3) Care Plus was positioned as ‘an extra layer of care’ and part of the routine high quality care pathway with an emphasis on family and carers; (4) efficient delivery of early palliative care at outpatient clinics alongside and integrated with regular cancer care delivery; (5) suggesting a ‘dose’ of a minimum number of consultations to address core palliative care tasks and establish relationships thereby facilitating future re-engagement when further complications or deterioration develops; and (6) timely case conference with usual General Practitioner, improving coordination and providing support to primary care.

Conclusion Through the incorporation of background evidence and engagement principles of implementation, Care Plus is an intervention designed to overcome the uncertainty and hesitation of introducing palliative care referral, and in turn, reduce the variation of timing and access to this form of care. The future integration of palliative care must now turn from demonstrating the benefits to the systematic implementation of models such as Care Plus, into real world practice.

Funding source NHMRC/MRFF Keeping Australians Out of Hospital Research Grant 1174028

* Presenting author