Health Experts’ Perspectives on Barriers, Facilitators, and Needs for Improvement of Hospital Care in the Dying Phase

Introduction. Globally, hospitals are an important place in end-of-life care and most frequent place of death in Germany (47%),
but at the same time, the least preferred one—both for patients and their informal caregivers. As hospital care in the dying phase
on non-palliative care wards has rarely been studied systematically, we assessed the current state of care in the dying phase in
hospitals as a 8rst step. Methods. In an online survey, N= 165 national health experts were invited to answer eight open questions
on care aspects, facilitators, barriers, and needs for improvement as well as COVID-19 pandemic speci8cs regarding hospital care
in the dying phase. Sociodemographic data were analysed descriptively, and responses were analysed using qualitative thematic
analysis. Results. Of n = 65 experts, 52% work as nursing sta@ and 30% as physicians. We identi8ed facilitators, barriers, and needs
for improvement regarding 11 topics on the following three levels: institutional level (general institutional conditions, hospital
culture, and integration of specialist palliative care), team level (attitude towards and dealing with death and dying, competencies,
communication, and teamwork) and care level (dying phase, symptom control, patient centredness, and involvement of informal
caregivers). Conclusion. Improving care in the dying phase has to overcome barriers on various levels. We assume that rather
“small” measures will 8nd their way into clinical routine and contribute to the improvement of hospital care in the dying phase.