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.

The prospect of death influences people’s thoughts about and how they deal with their remaining time. We aimed to understand whether patients with progressive, life-limiting diseases are oriented in the past, present, or future and how they deal with temporality. We conducted 57 in-depth interviews with end-of-life patients in 10 countries using thematic analysis at three levels (i.e., locally in three countries, with codes shared in the three-country subgroup, and in all 10 countries with a codebook that we developed). We found that the patients’ thoughts were oriented toward all three time levels (i.e., past, present, and future). Complementing these levels, we identified another, namely, the future after death. Each time level included patients actively and passively dealing with their thoughts. Past themes were remorse and regret, nostalgia, and coming to terms with past choices; present themes were feeling grateful for being alive, a time for farewells, and living for the day; future themes were worries about the future, to miss out, hope, ideas about death and dying, and planning the near future; and future after death themes were not being there, worries about loved ones, and preparations for a future after death. A changed view on lifetime and avoidance of thinking about a certain time level related to several time levels, while desire to die fluctuated between levels and between acting on and feeling about it. Living for the day, worries about the future, and worries about the well-being of loved ones were common themes in all countries.

Background: Experiences of serious illness, dying, death, and grief in the workplace significantly affect employee well-being, productivity, and organizational culture. Despite increasing recognition of their importance, there is limited understanding of workplace perspectives in Germany. This study addresses this gap by examining the attitudes and experiences of employees and employers regarding these issues to inform workplace policies that promote well-being and resilience. Methods: We conducted a nationwide representative cross-sectional online survey (n = 1,127) using a self-developed questionnaire with closed and open-ended items. Data were collected from managers and non-managers across multiple sectors to identify key themes, challenges, and opportunities for improving workplace practices. Closed-ended questions were analyzed quantitatively, and open-ended responses qualitatively. Findings: More than sixty-three percent (63.1%) of respondents reported having been affected within the past five years. Workplace support was limited, with 42.7% seldom or never receiving managerial support. Informal support from colleagues and managers was more common and often preferred over formal provisions. Employees valued understanding, empathy, and availability, whereas managers emphasized structural measures such as leave policies. Barriers, uncertainties, and a strong need for guidance and training were frequently reported. Employees in smaller companies expressed greater concerns about legal consequences and stronger support needs, while larger organizations more often offered formal guidelines and programs. Conclusions: The mismatch between employees’ needs and managerial focus underscores the importance of aligning workplace practices with employee expectations. Training, guidance, and initiatives that integrate psychosocial and structural support could strengthen well-being and enhance organizational resilience.

Uncertainty among healthcare providers about patients' ability to make care decisions is a barrier to shared decision-making. We aimed to assess the self-reported decision-making ability of patients with cancer at the end of life. Data from 11 countries of adults with a limited life expectancy and cancer as the primary diagnosis were used. Participants completed a questionnaire, including one item on decision-making ability and two on decision-making preferences. Correlations between self-reported ability and preferences were tested using Kendall's tau. Associations between decision-making ability and patient characteristics were determined using mixed-effects ordinal regression models. The sample (n = 1076, 53 % identified as men) had a mean age of 69 years (SD: 11.5). Among them, 80 % reported being able to make decisions about their life and care most of the time, 14 % some of the time, 5 % only a little of the time, and 2 % never. Regarding preferences, 95 % preferred to be involved in decision-making and 44 % preferred the doctors to make the decisions. These preferences were weakly correlated with decision-making ability (Kendall's tau: 0.13 and -0.11, respectively). Feeling able to make decisions was less likely for those institutionalized (versus living with relatives, OR: 0.26, 95 % CI: 0.12;0.55), those with tertiary education (versus primary/no education, OR: 0.43, 95 % CI: 0.22;0.85) and those without clear understanding of their health (versus those with understanding, OR: 0.29, 95 % CI: 0.16;0.52). Although most patients felt able to make decisions about their care, two out of every ten did not. About five out of ten preferred their doctors to make decisions. As almost all patients want to be involved in decisions, we suggest that providers discuss with patients how decisions will be made. This may enable providers to identify patients' needs and adapt the decision-making process to their abilities and preferences.

Background: Patients receiving palliative and hospice care frequently experience high symptom burden alongside altered body perception due to progressive disease and physical decline. While acupressure has demonstrated beneficial effects on symptoms such as nausea, pain, fatigue, and anxiety, its potential influence on body awareness has not been systematically investigated. Furthermore, evidence regarding the feasibility and implementation of nurse-led acupressure interventions across different palliative and hospice care settings remains limited. This study aims to explore the feasibility, acceptability, and potential effects of acupressure on symptom burden and body awareness in palliative care settings. Methods: This pilot study evaluates a nurse-led acupressure intervention aimed at improving body awareness in patients receiving palliative and hospice care across specialized inpatient and outpatient settings. This study is designed as a prospective, exploratory, mixed-methods pilot and feasibility study using a pre-post design across multiple care settings, including a palliative care unit, specialized palliative home care (SAPV), an inpatient palliative consultation service (PMD), and a hospice. A total of 60–80 adult patients with incurable illnesses will be recruited. The intervention consists of standardised acupressure administered by trained nursing staff, with at least two sessions per participant. Primary outcomes focus on feasibility and acceptability indicators, including recruitment, retention, adherence, intervention documentation, and data completeness. Exploratory clinical outcomes include symptom burden, body awareness, and use of on-demand medication. Quantitative outcomes include symptom burden (MIDOS), body awareness (State Mindfulness Scale—Body subscale), and use of on-demand medication. Qualitative data will be collected through brief patient interviews using the Body Image Assessment (BIA) and semi-structured interviews with patients and healthcare providers after the completed intervention. Data will be analysed using descriptive and exploratory inferential statistics, alongside a linguistic and thematic analysis. Quantitative and qualitative findings will be integrated using a convergent triangulation approach. Discussion: This study will provide first insights into the feasibility and acceptability of acupressure in palliative and hospice care and generate hypotheses regarding its potential effects on symptom relief and body awareness. Findings will inform the design of a future randomized controlled trial and contribute to the implementation of complementary therapies in integrative palliative care.

Background: Society often perceives work and private life as separate spheres which leads to uncertainty about issues such as serious illness, dying, death, and grief within workplace settings. Last Aid Courses (LAC) are established to reduce uncertainty and insecurity towards these issues in the public, but not designed for use in the workplace. Objectives: To develop an integrated framework specifically designed for the workplace context to foster compassionate workplaces. Methods: After performing 102 LAC in different workplace settings, a mixed-methods design was employed, comprising (a) an online survey among participants (n = 611) including closed questions and open free-text questions, and (b) five focus groups with former course participants (n = 24). Results: The vast majority of respondents (94.5%) considered both the topics addressed and the conduction of LAC in the workplace as highly relevant. This relevance was reflected in increased confidence in dealing with the subject matter (96,0%) and a high willingness to recommend the course to others (98.3%). Participants expressed the need for stronger integration of workplace-related topics, particularly concerning grief management, communication training, and labor-law-related aspects. The qualitative data revealed three interrelated levels: 1. Personal level: Dealing with those affected, consisting of shared experience, trust, and the impact of grief on employees; 2. Company level: Structural factors, including (a lack of) managerial support, attitude, and established structures; 3. Development level: Conceptual input encompassing characteristics of potential last aiders in the workplace, ideas for institutionalization, best practice, being integrated into the company structure, support for potential future last aiders, and barriers. Conclusion: Our findings confirm the high relevance of the topic within workplace settings and demonstrate that LAC enhance confidence in dealing with serious illness, dying, death, and grief. The complexity of the issue highlights that sustainable implementation requires workplace-specific approaches. Personal and structural dimensions are closely intertwined and form part of a framework aimed at strengthening workplace-based confidence in responding sensitively to serious illness, dying, death, and grief.