Background Patients with haematological malignancy frequently do not access palliative care, moreover, for those who do, access is frequently late in the illness.

Aims To understand the implementation of early palliative care integration for people with multiple myeloma across four cancer treatment centres in Victorian and South Australia.

Methods A stepped wedge, multi-site implementation clinical trial testing usual care (control) versus Care Plus (early palliative care integration as practice change) following the Consolidated Framework of Implementation Research. Care Plus (early palliative care) was introduced at a standardised point(s) in the illness, either at time of diagnosis or time of first relapse of multiple myeloma. Qualitative interviews with health professionals, patients and families were conducted to explore the implementation processes of Planning, Engagement, Practice Change and Evaluation across hospital sites. Interview transcripts were thematically analysed by making codes and categories with emerging themes. Consolidated criteria for Reporting Qualitative research guidelines were used to maintain rigour.

Results Nineteen semi-structured interviews via zoom referred to the care of people with multiple myeloma. These interviews involved haematologists (n=4), palliative care physicians (n=8), clinical nurses (n=3) and patients (n=4). Patients and clinicians reported satisfaction with the implementation of Care Plus. Major themes included (1) benefits of standardised points for referral to early palliative care, (2) development of strategies for introducing early palliative care to patients and carers; (3) enhanced collaborative practice between haematology and palliative care teams; and (4) the time and value of exploring goals and planning for the future available with early palliative care including asymptomatic patients.

Conclusions Care Plus facilitated enhanced access to palliative care for patients with multiple myeloma including at time of diagnosis. For haematology clinicians this Care Plus model appeared to provide an opportunity to ‘re-imagine’ how palliative care may be delivered and the role it plays in patient care.

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