Adapting a palliative care intervention for people with advanced cancer across seven European countries : the Pal-Cycles intervention

Hooley, Rachel and Payne, Sheila and Brunsch, Holger and Surges, Severine Marie and Mosoiu, Daniela and Hurducas, Flavia and Hernández-Marrero, Pablo and Pereira, Sandra Martins and Csikós, Ágnes and Pozsgai, Éva and Leppert, Wojciech and Forycka-Ast, Maria and van den Brand, Pippa and Hasselaar, Jeroen and Preston, Nancy (2026) Adapting a palliative care intervention for people with advanced cancer across seven European countries : the Pal-Cycles intervention. BMC Palliative Care, 25 (1): 181. ISSN 1472-684X

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Abstract

Background: International adaptation of healthcare interventions requires sensitivity to local contexts, especially in palliative care, where healthcare systems and cultural expectations about end of life differ widely. Pal-Cycles is an intervention that aims to improve transitions in care for patients with advanced cancer. This intervention was adapted for implementation in a stepped wedge trial across seven European countries (Germany, Hungary, the Netherlands, Poland, Portugal, Romania and the UK). This paper aims to illustrate the process of adapting a palliative care intervention (Pal-Cycles) to meet the needs of those using healthcare settings across seven European countries. Methods: Adapted nominal group techniques (a structured group method that supports idea generation, discussion, and prioritisation) were used, involving both in-country and cross-country adaptation meetings focused on the five key components of the original intervention design, to ensure cultural sensitivity and best fit All countries established a group of clinicians and all except two countries (Portugal and Hungary) involved groups of patients and families. The adaptation process occurred in a series of 5 meetings, which were mostly held online to accommodate participants’ schedules. Results: A total of 36 clinicians, 14 patients or family members, and 16 facilitators participated in the adaptation process over a four-month period. Structured guidance and iterative consultation meetings ensured that the final intervention was both standardised and adaptable to each country’s healthcare setting. We produced a standardised intervention manual based on a theory of change model, ensuring consistency across countries while allowing for contextual flexibility. Conclusions: This paper provides guidance for future cross-cultural adaptation of palliative care interventions, illustrating the value of detailed methodological planning, structured guidance, and multi-stakeholder engagement in the adaptation process. Trial registration: ClinicalTrials.gov NCT06259136, registered on 6 February 2024.