PAL-CYCLES

Many patients with advanced terminal cancer leave hospital without continuity of information and certainty of further treatment and care. Often, communication between healthcare providers in different settings is sub-optimal, resulting in poor continuity and coordination of care, a negative impact on quality of life and an increase in avoidable hospitalizations. The Pal-CYcles program is a transitional palliative care program for patients with advanced cancer, adaptable to local cultures and healthcare systems. The program offers an intervention for a smooth transition from hospital to community care, consisting of five core components: (1) identification of a patient with palliative and supportive care needs in collaboration with the oncologist and hospital palliative care team; (2) compassionate communication with the patient and family; (3) a collaborative multidimensional care plan and follow-up in the home care setting; (4) periodic evaluation of the care plan with patients and their loved ones; (5) identification of the terminal phase (if applicable) on the basis of periodic assessments, with appropriate intensification of care and end-of-life interviews according to local possibilities and habits, including consultation with the patient and families on ethically and legally sensitive issues. This program will be implemented and evaluated in seven European countries through a tiered randomized controlled trial design. The experiences of patients, relatives and healthcare providers, as well as ethical and equity issues, will be addressed using qualitative methods. The Pal-Cycles program will facilitate patient-centered communication and continuity of palliative cancer care within community care, reducing unplanned hospitalizations and improving quality of life for patients with advanced cancer at the end of life.