How can integration of oncology and palliative care services be achieved for optimal patient benefit? Stakeholders’ perspectives in Zimbabwe

BACKGROUND: Cancer is a main driver of death with serious health-related suffering. The growing body of evidence for early integration of palliative care alongside oncological treatment to optimises patient-reported outcomes is almost exclusively from high-income countries whilst the greatest need is in low- and middle-income countries (LMICs). We aimed to explore the perspectives of patients, families and clinical staff on what constitutes a feasible, acceptable and appropriate model of integrated palliative and oncology care in Zimbabwe. MATERIALS AND METHODS: We conducted an exploratory qualitative study underpinned by indicators for integrated oncology and palliative care. Participants comprised healthcare professionals, patients & families. Semi-structured guides were developed and iteratively refined. Deductive framework analysis was conducted to Hui's evidence-based framework of integrated oncology and palliative care indicators. The data was then further inductively coded into the framework. RESULTS: Analysis of data from 45 stakeholders (n = 15 per group) identified 19 of 38 indicators (50%) aligned with Hui's model, indicating partial and uneven integration. Alignment was strongest in clinical processes (n = 9) and education (n = 5), with more limited support for administration (n = 3) and structure (n = 2). No findings aligned with the research domain. Inductive coding identified three indicators which aligned with clinical processes (routine discussion of prognosis, advance care planning and goals), clinical structure (physical environment) and education (training needs). DISCUSSION: While the Hui model is broadly applicable, substantial contextual adaptation is required. Integration cannot be achieved through coordination alone and requires system-level investment in workforce, training, infrastructure, and policy. We propose a phased "minimum package" for integration tailored to Zimbabwe and similar LMICs settings. IMPLICATIONS FOR PRACTICE: Our findings highlight the need to strengthen multi-professional collaboration and communication in oncology settings. Although tumour board meetings involve surgeons, oncologists, radiologists, and pathologists, they do not routinely include palliative care specialists such as social workers and psychologists. Including palliative care team members could broaden discussions to address symptom control, goals of care, and communication of difficult news.Developing a contextually relevant model that incorporates both existing and newly identified indicators of integration may help patients, families, and health systems realise the benefits of integrated oncology and palliative care.