1.Title of the Research Paper:

We need time, a great know-how, and security for patients to always be there in time”: a qualitative study on factors distinguishing General from Specialized Palliative Home Care.

2.Authors & Affiliations:

Melanie Joshi1*†, Kim Dillen1†, Norbert Krumm2, Michaela Hesse3, Holger Brunsch4, Julia Strupp1, Lukas Radbruch4,5, Roman Rolke2,6, Raymond Voltz1,7,8 and on behalf of the APVEL Consortium 1 Faculty of Medicine and University Hospital, Department of Palliative Medicine, University of Cologne, Cologne, Germany. 2 Department of Palliative Medicine, Medical Faculty RWTH Aachen University, Aachen, Germany. 3 Institute for Digitalization and General Medicine, RWTH Aachen University, Aachen, Germany. 4 Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany. 5 Centre for Palliative Medicine, Helios Hospital Bonn/ Rhein-Sieg, Bonn, Germany. 6 Faculty of Medicine and University Hospital, Center for Integrated Oncology, Aachen Bonn Cologne Duesseldorf (CIO ABCD), Aachen, Germany. 7 Faculty of Medicine and University Hospital, Center for Health Services Research, University of Cologne, Cologne, Germany. 8 Faculty of Medicine and University Hospital, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf (CIO ABCD), Cologne, Germany.

3.Abstract/Summary:

Background: An increasing number of patients in the palliative phase of their disease are cared for at home by palliative home care services. A sense of security, normality of everyday life, and symptom control are found to be active factors of quality of care in Specialized Palliative Home Care. Whether this also applies to General Palliative Home Care has not yet been systematically investigated. The aim of this study was to identify distinctions between General and Specialized Palliative Home Care from a healthcare professional’s perspective concerning those factors.

Methods: With a qualitative approach, we conducted 11 semi-structured interviews with healthcare professionals from different professional backgrounds in General and/or Specialized Palliative Home Care.

Results: In both General and Specialized Palliative Home Care, healthcare professionals (HCP) found a sense of security (through availability) to be most relevant for the patients. The majority saw aspects of normality of everyday life as a key component for high-quality palliative home care, especially having time for the patient and the family caregiver(s). However, statements about symptom control are mainly related to Specialized Palliative Home Care. The subcodes availability, having time and competence, symptom burden and financial resources were the main distinguishing factors between General and Specialized Palliative Home Care in sense of security, normality of everyday life and symptom control, respectively.

Conclusions: Our results provide the basis for a clearer definition of GPHC and SPHC and contribute to identifying factors for a transferal between the two services to provide best care for the patient. Distinguishing (sub)factors revealed challenges and short-term solutions. Providing (financial) incentives to guarantee time and availability in General Palliative Home Care would lead to more effective care.

4.Publication Details:

BMC Health Services Research, "So at least now I know" published online 13-Feb-25

6.Key Findings & Implications

From a healthcare professional’s perspective, to ensure effectiveness in both settings of palliative home care, the guaranteed availability of physicians and having time for the care of patients and relatives is crucial. Individual solutions for challenges, e.g., giving time without being reimbursed for it or finding committed physicians who are available for GPHC nurses beyond office hours, tend to work as a short-term solution. Nevertheless, as a long-term solution, increasing financial resources and providing incentives to guarantee more time and availability in GPHC would lead to more effective care and patient satisfaction.

7. Citation Information:

Joshi, M., Dillen, K., Krumm, N., Hesse, M., Brunsch, H., Strupp, J., ... & APVEL Consortium Pfaff Holger Scholten Nadine Hellmich Martin Rietz Christian Meyer Ingo Fink Robin. (2025). " We need time, a great know-how and security for patients to always be there in time”: a qualitative study on factors distinguishing General from Specialized Palliative Home Care. BMC Health Services Research, 25(1), 245.

8.Keywords/Tags:

Palliative home care, Qualitative interviews, Healthcare professionals, General palliative home care, Specialized palliative home care.

9.Related Research or Articles

Seipp, H., Haasenritter, J., Hach, M., Becker, D., Ulrich, L. R., Schütze, D., ... & Kuss, K. (2021). How can we ensure the success of specialised palliative home-care? A qualitative study (ELSAH) identifying key issues from the perspective of patients, relatives and health professionals. Palliative medicine, 35(10), 1844-1855.Michel, C., Seipp, H., Kuss, K.,

Hach, M., Kussin, A., Riera-Knorrenschild, J., & Bösner, S. (2023). Key aspects of psychosocial needs in palliative care-a qualitative analysis within the setting of a palliative care unit in comparison with specialised palliative home care. BMC palliative care, 22(1), 100. Dillen, K., Joshi, M., Krumm, N., Hesse, M., Brunsch, H., Schmidt, H., ... & Voltz, R. (2021). Availability as key determinant in the palliative home care setting from the patients’ and family caregivers’ perspectives: A quantitative-qualitative-content analysis approach. Palliative & supportive care, 19(5), 570-579. Danielsen, B. V., Sand, A. M., Rosland, J. H., & Førland, O. (2018). Experiences and challenges of home care nurses and general practitioners in home-based palliative care–a qualitative study. BMC palliative care, 17, 1-13.