Cultural and structural shifts towards early palliative care: stakeholder perspectives on implementing palliative care identification and needs assessment tools in a hospital setting - a focus group study from Denmark

Abstract

Early identification of palliative care needs is essential for patients with life-limiting illness to enhance their quality of life. Despite the recognised benefits of systematic identification and needs assessment tools, consistent implementation within hospital settings remains a challenge. This study aimed to explore healthcare stakeholders’ perceptions of barriers and facilitators to the implementation of palliative care identification and needs assessment tools, while eliciting stakeholder-driven perspectives on potential implementation strategies within a hospital setting. This pre-implementation qualitative study utilised a purposive sampling strategy. Four homogenous focus group interviews were conducted in November 2024 with eleven stakeholders (leaders, physicians, nurses, physio- and occupational therapists). Data were analysed abductively, drawing on Critical Realism to explore underlying generative mechanisms. Subsequently, findings were deductively mapped onto the Consolidated Framework for Implementation Research. One overarching theme: Cultural and Structural Shifts Towards Early Palliative Care , and five sub-themes were identified: (1) The Need for Standardisation and a Shared Language ; (2) Unstructured Palliative Practice and Interprofessional Discrepancies ; (3) Attitudinal Hesitation and Knowledge Gaps ; (4) Practical and Structural Implementation Challenges ; and (5) The Critical Role of Leadership and Vision . Key barriers included a knowledge gap regarding general palliative care and a hesitation to discussing future care. Stakeholders suggested that implementation could be facilitated by a shift from person-dependent practices toward standardised workflows, integrating tools into electronic health records, proactive leadership, and the de-stigmatisation of palliative terminology through targeted education. The findings indicate that implementation of tools could be facilitated by a coordinated, systemic shift beyond superficial compliance toward a shared interprofessional responsibility. The study highlights the potential necessity of visionary leadership to foster interdisciplinary integration and address cultural and structural changes. These insights provide a stakeholder-driven foundation for developing targeted implementation strategies in a hospital setting.