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Team-based outpatient early palliative care: a complex cancer intervention
  1. Camilla Zimmermann1,2,
  2. Suzanne Ryan1,2,
  3. Breffni Hannon1,2,
  4. Alexandra Saltman1,2,
  5. Gary Rodin1,3,
  6. Ernie Mak1,4,
  7. Ahmed Al-Awamer1,4 and
  8. Jenny Lau1,4
  1. 1Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  2. 2Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
  4. 4Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Camilla Zimmermann, Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada, M5G 2M9; camilla.zimmermann{at}


Background Although the effectiveness of early palliative care for patients with advanced cancer has been demonstrated in several trials, there has been no detailed published description of an early palliative care intervention.

Method In this paper, we delineate the iterative conception and systematic evaluation of a complex intervention called team-based outpatient early palliative care (TO-EPC), and describe the components of the intervention. The intervention was developed based on palliative care theory, review of previous palliative care interventions and practice guidelines. We conducted feasibility testing and piloting of TO-EPC in a phase 2 trial, followed by evaluation in a large cluster randomised trial and qualitative research with patients and caregivers. The qualitative research informed the iterative refinement of the intervention.

Results Four principles and four domains of care constitute a conceptual framework for TO-EPC. The main domains of care are: coping and support, symptom control, decision-making and future planning. The main principles are that care is flexible, attentive, patient-led and family-centred. The most prominent domain for the initial consultation is coping and support; follow-up visits focus on symptom control, decision-making to maximise quality of life and future planning according to patient readiness. Key tasks are described in relation to each domain.

Conclusion The description of our intervention may assist palliative care teams seeking to implement it, researchers wishing to replicate or build on it and oncologists hoping to adapt it for their patients.

  • cancer
  • palliative care
  • palliative medicine
  • early medical intervention
  • outpatients

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  • Contributors All the authors contributed to the conception or design of the work. CZ drafted the work, and all the authors revised it critically for important intellectual content. All the authors approved the final version, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • Funding This research was funded by the Canadian Cancer Society (grant #700862; CZ), the Canadian Institutes of Health Research (grant #152996; CZ) and the Ontario Ministry of Health and Long-Term Care. CZ is supported by the Rose Family Chair in Supportive Care, Faculty of Medicine, University of Toronto.

  • Disclaimer The sponsors had no role in the design; in the collection, analysis and interpretation of data informing the paper; in the writing of the report or in the decision to submit the paper for publication.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement There are no data in this work.