Background Pancreatic cancer is known for its late symptom onset, high pain burden and low survival rates. The management of pancreatic cancer requires a holistic approach to improve patient outcomes. The development of a clear referral pathway for early palliative care is crucial to improve the experience of patients with pancreatic cancer and their families.

Aim To develop an evidence-based and community-informed pathway, with associated clinical guidance and implementation plans, for early access to palliative care for people with pancreatic cancer.

Method The pathway development involved a longitudinal iterative approach. Literature reviews were conducted alongside extensive stakeholder and expert consultation with individuals (n=84) from all states and territories in Australia. A range of groups were represented including clinicians, consumers, peak body organisations, culturally and linguistically diverse groups and Aboriginal and Torres Strait Islander communities. A deliberative dialogue approach was adopted to review existing evidence and was complemented by lived and clinical experience to shape the outcomes.

Results The referral pathway to early palliative care for people with pancreatic cancer was developed based on evidence and recommended best practice. It highlights the:

• referral to be triggered by diagnosis of unresectable disease for all patients

• importance of presence of palliative care representation at cancer multidisciplinary meetings

• role of cancer care coordinators to facilitate patient identification and referral to palliative care at any time according to needs, including prior to multidisciplinary meeting

• importance of screening for pain at each patient contact

• language around introducing early palliative care to patients to overcome barriers and fears

• role of outpatient consultation including by telehealth for people having anti-cancer treatment

• opportunity for stable patients to continue with anti-cancer care only after tasks of palliative care are assessed/addressed, with the understanding that the patient can link back into palliative care at future point when needs escalate

• smooth transition to community and inpatient palliative care as end of life nears.

Conclusion The National Pancreatic Cancer Roadmap, developed by Cancer Australia, set out work to establish standardised care pathway to early palliative care for people with pancreatic cancer, with accompanying clinical guidance at key stages of the pathway. The implementation of this pathway is the next step to provide equitable care and improve the experience of people affected by pancreatic cancer.

This project is funded by Cancer Australia, National Pancreatic Cancer Roadmap – Delivery of early implementation priorities.