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BACKGROUND
Recently, the concept of integrating oncology and palliative care has gained wide professional and scientific support; however, a global consensus on what constitutes integration is unavailable. We conducted a Delphi Survey to develop a consensus list of indicators of integration of specialty palliative care and oncology programs for advanced cancer patients in hospitals with ≥100 beds.

DESIGN
International experts on integration rated a list of indicators on integration over 3 iterative rounds under 5 categories: clinical structure, processes, outcomes, education and research. Consensus was defined a priori by an agreement of ≥70%. Major criteria (i.e. most relevant and important indicators) were subsequently identified.

RESULTS
Among 47 experts surveyed, 46 (98%), 45 (96%) and 45 (96%) responded over the 3 rounds. 19 (40%) were female, 24 (51%) were from North America and 14 (30%) were from Europe. 16 (34%), 7 (15%) and 25 (53%) practiced palliative care, oncology and both specialties, respectively. After 3 rounds of deliberation, the panelists reached consensus on 13 major and 30 minor indicators. Major indicators included 2 related to structure (consensus 95-98%), 4 on processes (88-98%), 3 on outcomes (88-91%) and 4 on education (93-100%). The major indicators were considered to be clearly stated (9.8/10), objective (9.4/10), amenable to accurate coding (9.5/10) and applicable to their own countries (9.4/10).

CONCLUSIONS
Our international experts reached broad consensus on a list of indicators of integration, which may be used to identify centers with a high level of integration, and facilitate benchmarking, quality improvement and research.