Adapting a palliative care intervention across seven European countries: The Pal-Cycles intervention

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 across seven European countries. 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 were used, which involved the use of both in country and cross-country adaptation meetings focussed on the five key components of the original intervention design, to ensure cultural sensitivity and best fit. Each country convened a group of clinicians and five countries also convened a secondary group of patient and family members. The adaptation process occurred in a series of 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. Conclusions This paper provides a model 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.