A new cross-disciplinary model for early integration of palliative care for patients with incurable cancer - an intervention development study

BackgroundPatients with incurable cancer face complex physical, psychological, social, andexistential challenges. Early integration of palliative care (PC) has proven essential toimproving quality of life and well-being, yet implementation remains inconsistent andoften delayed. To address this gap, we developed the Cross-PALL model, a crossdisciplinary approach to integrate PC across oncology and primary care.MethodsFollowing the Medical Research Council’s framework for complex interventions, weused a participatory design approach to develop the model in collaboration with keystakeholders, including patients, their relatives, healthcare professionals fromoncology, primary care, municipal services and representatives from voluntaryorganizations. Development involved iterative phases of evidence synthesis, needsassessment, field studies, collaborative workshops, and prototyping. For each of thesephases, various methods and activities are applied to enhance genuine participationfrom all collaborators.Implementation determinants were continuously identified using the ConsolidatedFramework for Implementation Research, and a logic model was constructed to linkdeterminants, implementation strategies, mechanisms, and outcomes.ResultsThe Cross-PALL model is structured as a standardized care pathway designed toensure systematic, person-centered, and coordinated PC. Key components includeearly initiation of PC at diagnosis, routine patient-reported outcome assessments,decision aids, navigation support, structured inter-sectoral communication, andintegration of advance care planning.ConclusionThe Cross-PALL model offers a feasible, scalable, evidence-informed approach tostrengthen early PC integration in oncology. By combining implementation scienceACCEPTED MANUSCRIPT ARTICLE IN PRESSARTICLE IN PRESSwith participatory design, the model aims to enhance relevance, sustainability, andcontinuity of care, ultimately supporting patients’ quality of life and well-being.