BMJ supportive & palliative care · 2026
Complexity of providing general palliative care: a hospital-wide qualitative interview study.
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Drachmann Isabella, Bergenholtz Heidi, Benthien Kirstine Skov
Аннотация
OBJECTIVES: Although specialised palliative care is recommended for patients with refractory or complex symptoms, only a minority receive such care. Consequently, most patients rely on general palliative care delivered in hospitals or primary care, yet this practice remains poorly described. This study aimed to explore how general palliative care is organised, practised and experienced across clinical departments in a university hospital.
METHODS: This qualitative study used semistructured interviews and qualitative content analysis in a Danish regional university hospital serving approximately 600 000 citizens. A total of 20 informants from all clinical departments, including nurse managers, senior physicians, floor nurses and nurses with advanced roles, participated in 10 individual and five dyad interviews.
RESULTS: Three overarching themes emerged: 'a palliative care approach', 'general palliative care tools and practice' and 'intersections with specialised palliative care'. Patient identification relied primarily on implicit or explicit clinical triggers rather than systematic screening. Many departments provided palliative care without naming it as such, particularly needs assessments, life-sustaining treatment decisions and end-of-life planning. Collaboration with specialised palliative care was influenced by unclear referral criteria and capacity limitations, although informal consultations and teaching were highly valued. Participants expressed a strong wish for more knowledge transfer and structured guidance from specialised palliative care.
CONCLUSIONS: General palliative care in hospitals is variably recognised and inconsistently organised. The pervasive presence of complexity in general palliative care challenges the utility of 'complexity' as an effective criterion for distinguishing general from specialised palliative care.
METHODS: This qualitative study used semistructured interviews and qualitative content analysis in a Danish regional university hospital serving approximately 600 000 citizens. A total of 20 informants from all clinical departments, including nurse managers, senior physicians, floor nurses and nurses with advanced roles, participated in 10 individual and five dyad interviews.
RESULTS: Three overarching themes emerged: 'a palliative care approach', 'general palliative care tools and practice' and 'intersections with specialised palliative care'. Patient identification relied primarily on implicit or explicit clinical triggers rather than systematic screening. Many departments provided palliative care without naming it as such, particularly needs assessments, life-sustaining treatment decisions and end-of-life planning. Collaboration with specialised palliative care was influenced by unclear referral criteria and capacity limitations, although informal consultations and teaching were highly valued. Participants expressed a strong wish for more knowledge transfer and structured guidance from specialised palliative care.
CONCLUSIONS: General palliative care in hospitals is variably recognised and inconsistently organised. The pervasive presence of complexity in general palliative care challenges the utility of 'complexity' as an effective criterion for distinguishing general from specialised palliative care.