PRiSM project: e-Delphi study on the role of specialist palliative care services in the care of people with stable locally advanced or metastatic cancer.

PURPOSE: More individuals are living longer with advanced/metastatic cancer, but they can suffer burdensome physical, psychological, social, and spiritual problems. Specialist palliative care services (SPCS) have traditionally supported people with advanced disease, but this group faces unique problems that require different strategies, and clarity about the role of SPCS is lacking. This study aims to generate European expert consensus opinion about this role. METHODS: European specialist palliative care (SPC) and oncology experts from international/national and patient advocacy organisations were invited to participate in a wider electronic Delphi study about the role of SPCS for people who have/had cancer. Participants ranked agreement with questions/statements based on literature reviews across three rounds, whilst suggesting modifications and reviewing answers relevant to group responses. Consensus was pre-defined as ≥ 75%, Spearman's rank order correlation identified stability between rounds, and the chi-square test for goodness of fit compared group results. RESULTS: Eighty-six SPC experts and 54 oncology experts from across Europe participated in the study. Seventy relevant statements reached consensus. The experts agreed that SPCS should support cancer-related and cancer treatment-related physical problems, alongside other holistic aspects, within a dedicated multidisciplinary team. However, SPCS require further training about certain pain management strategies, psychological therapies, and adverse effects of anticancer treatments. Lack of resources and misperceptions about SPCS are barriers to service extension. CONCLUSION: This study has generated European expert consensus statements about the role of SPCS in supporting people with locally advanced or metastatic cancer. Results will be used to inform a model of care.