P15.10.B TOWARDS EARLY INTEGRATION OF PALLIATIVE CARE IN GLIOBLASTOMA PATIENTS: CO-DESIGN OF AN INTEGRATED CARE PATHWAY AND ALTERNATIVE PAYMENT MODEL

Abstract BACKGROUND Despite the significant symptom burden and incurable nature of glioblastoma, palliative care is often introduced late and is not consistently part of routine practice. Care delivery remains fragmented, with limited coordination between providers, resulting in suboptimal advance care planning (ACP), inadequate symptom management and insufficient psychosocial support. Early integration of palliative care can better address the needs of patients and caregivers, improve quality of life, and reduce unnecessary care in the end of life phase. Consequently, there is a critical need to systematically integrate palliative care into routine neuro-oncological care. Alternative payment models (APM) can incentivize timely and integrated palliative care by aligning reimbursement with high-quality and coordinated care instead of rewarding the volume of services. This study aims to design an integrated care pathway and APM to support the early integration of palliative care for patients with glioblastoma. METHODS We used participatory design research, engaging stakeholders from neuro-oncology, specialty palliative care, primary care, district nursing, healthcare administration, health insurance, health economics, and patient advocacy. The design process consisted of three phases and involved 13 informal interviews (with healthcare professionals (HCPs), patients or caregivers), six expert meetings and two co-design workshops. RESULTS In phase 1, we mapped the current care pathway and identified barriers to early palliative care integration. Major barriers included: 1) variation in timing and need of ACP, 2) HCP hesitation in initiating ACP, 3) unclear referral triggers for specialist palliative care, 4) inadequate coordination between primary and secondary care, 5) limited experience with glioblastoma in primary care due to low prevalence. In phase 2, iterative prototyping was used to design a care pathway, including a protocol with referral triggers. Key components include: initiation of ACP by neuro-oncologist within six weeks after diagnosis, transmural multidisciplinary team meeting before treatment in complex cases, ongoing transmural coordination, referral to specialist palliative care, and caregiver aftercare. Phase 3 is currently ongoing, during which we develop and evaluate scenarios for an APM. The APM should minimize administrative burden given the small patient population and be scalable to other oncological conditions. CONCLUSION The co-designed integrated care pathway offers a feasible and scalable framework for systematically integrating early palliative care for patients with glioblastoma. Next steps include establishing contractual agreements, implementing the pathway and APM, and evaluating patient, clinical and system-level outcomes. FUNDING by the Netherlands Organization for Health Research and Development (ZonMw).