Background Despite global evidence for the benefits of early palliative care integration into advanced cancer care, there remain gaps in translation into practice, with limited information about the effective implementation strategies to effect this translation.

Aim To introduce the Care Plus implementation toolkit package as an online resource and understand its utility in the implementation and ongoing sustainability of palliative care integration into advanced cancer services across metropolitan oncology services in Australia.

Design, Methods Guided by the UK Medical Research Council methodological framework for developing complex interventions, Care Plus, a model of early palliative care designed to address existing barriers to this approach, was delivered through a multi-site stepped wedge, mixed methods implementation study across four Victorian and South Australian hospitals. Based on the qualitative interviews and ethnographic data emerging from this study, the effective (and ineffective) implementation strategies were reviewed. Informed by these findings, an implementation toolkit was developed for healthcare providers to operationalise a standardised and integrated approach to palliative care for advanced cancer patients as part of routine organisational practice.

Results After conducting 49 interviews with palliative care consultants, oncologists, nurses, patients and carers in the Care Plus study to receive feedback, and in order to effectively establish and evaluate the outpatient-focused Care Plus model co-designed with relevant referring and palliative team, the Care Plus implementation toolkit (https://www.careplusau.org/about-5) was developed as an online resource, guiding the implementation of the Care Plus pathway through three phases-Planning and Engagement, Implementation, and Maintenance. The implementation strategies, core activities, and supporting materials directly addresses barriers to why, who, when, and how patients can access early and integrated palliative care at nominated trigger points with organisational processes flexible to local context. The Care Plus toolkit offers improved understanding of strategies to underpin successful implementation, translation and ongoing evaluation of early integrated palliative care for advanced cancer.

Conclusions/lessons learned The Care Plus toolkit (freely available online) provides a platform to focus on systemic implementation of tailored early palliative care models in advanced cancer streams into real world practice, which could be the basis of future mixed-methods studies.

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