How are transitions from oncology to palliative care regulated across Europe? A grey literature review in eight countries : Pal-Cycles project

Garralda, Eduardo and Radojičić, Tamara and Payne, Sheila and Hooley, Rachel and Busa, Csilla and Koper, Ian and Leppert, Wojciech and Reigada, Carla and Hurducas, Flavia and Brunsch, Holger and Belar, Alazne and Centeno, Carlos and Hasselaar, Jeroen and Arantzamendi, María (2026) How are transitions from oncology to palliative care regulated across Europe? A grey literature review in eight countries : Pal-Cycles project. Health policy (Amsterdam, Netherlands), 164: 105522. ISSN 1872-6054

Abstract

Patients with advanced cancer often encounter significant challenges during the transition from oncology to palliative care, particularly due to hospital discharges that lack clear communication and follow-up plans. This discontinuity in care may be addressed through various regulatory strategies designed to facilitate smooth transitions. To investigate the regulatory landscape governing transitions from oncology to palliative care across eight European countries. A grey literature review followed by a comparative analysis of identified documents was carried out. A total of 20 professional guidelines, strategies, and regulations in England, Germany, the Netherlands, Portugal, and Spain were identified. Identified documents provided inconsistent guidance regarding the promotion of care continuity. Notably, several essential components for ensuring effective transitions were identified across countries: the formulation of collaborative protocols between various levels and types of care, the establishment of clear transition and referral criteria, early identification of palliative care needs, synchronization of patient information across care levels, involvement of family members in the care process, implementation of a comprehensive four-dimensional patient assessment, and regular evaluation and revision of care plans. Certain elements, such as the role of primary care professionals in identifying palliative care patients, realistic discharge timelines, effective communication with patients and families, and approaches to advance care planning and shared decision-making, were inconsistently identified across different countries. To enhance continuity of care for patients transitioning from oncology to palliative care at different levels, it is imperative to develop targeted guidance that incorporates all pertinent elements of care coordination. [Abstract copyright: Copyright © 2025. Published by Elsevier B.V.]