Has the Early Majority Been Reached? Specialised Inpatient Palliative Care Utilisation in Common Solid Tumours in Germany.

Background

Randomised trials indicate that early integration of specialised palliative care improves quality of life and, in some studies, survival in advanced cancer, yet its implementation in inpatient oncology remains inconsistent. This study quantifies the coded utilisation of specialised inpatient palliative care in German hospitals and interprets adoption patterns using the diffusion of innovations theory.

Methods

We conducted a cross-sectional analysis of nationwide hospital cases reimbursed under the German diagnosis-related groups (DRG) system in 2023. The analysis included the most common solid malignancies and assessed the utilisation of specialised inpatient palliative care overall and stratified by metastatic status, tumour entity, comorbidities, and treating medical specialties.

Results

Specialised inpatient palliative care was provided in 5.4% of hospital cases involving the most common malignant tumours. Among patients with organ metastases, utilisation increased to a median rate of 15.0% of hospital cases, with the highest rates observed in cases with brain (17.8%), bone (17.0%), and pleural metastases (16.1%). Palliative care involvement correlated positively with in-hospital mortality. Interpreted cautiously through the diffusion of innovations theory, which frames the 15 to 20% band as a heuristic landmark rather than a validated threshold, utilisation even in the metastatic subgroup reaches only the lower edge of this band, indicating that uptake remains confined to innovators and early adopters and has not extended to the early majority.

Conclusions

Specialised inpatient palliative care remains underutilised in German oncology, reaching 5.4% of all cases and a median of 15.0% even in metastatic disease. Interpreted cautiously through the diffusion of innovations theory, which frames the 15 to 20% band as a heuristic landmark, uptake appears confined to early adopters and has not yet reached the early majority.