Attitudes and beliefs of Italian palliative care experts regarding cachexia: A Delphi study

Abstract

Introduction:

Cachexia is a multifactorial syndrome prevalent in advanced illness. Guidelines rarely integrate the relational, multidimensional perspective of palliative care (PC). Addressing this gap is essential to optimize care. To achieve this, national consensus among PC physicians and nurses on principles and priorities for managing cachexia within PC settings is necessary.

Methods:

A two-round Delphi study was conducted with 43 Italian PC experts (29 physicians, 14 nurses) meeting ⩾10 years’ experience criteria. In Round 1, participants answered open-ended questions informed by literature and a prior exploratory study. Qualitative Framework Method analysis generated 28 statements. In Round 2, statements were rated on a 5-point Likert scale; consensus was defined as ⩾90% agreement (scores 4 or 5).

Results:

Response rates were 82.2% (Round 1) and 95.5% (Round 2). High consensus (⩾90%) from both physicians and nurses was reached for 14 of 28 statements. Unanimous agreement (100%) supported the need for multiprofessional management, assessment of symptom clusters, and reframing the meaning of food in relation to illness stage. Strong agreement was found for dyadic care planning (97.7%), oral care (97.7%), and body image assessment (95.3%). Lower consensus occurred for prioritizing nutritional deficits (55.8%) and routine CRP/prealbumin testing (34.5%), reflecting contextual and prognostic considerations.

Conclusions:

This study defines core PC-oriented principles for cachexia management: interprofessional collaboration, dyadic engagement, early holistic assessment, and goal-concordant interventions. Findings can inform future clinical guidelines, training, and policy development to address cachexia in advanced illness.