General palliative hospital care - a Danish nationwide survey of organization and clinical practice

BACKGROUND: Most patients end their life with general palliative care offered by healthcare providers in non-palliative care focused/specialized departments. The state of how this care is organized and adherence to the Danish board of health recommendations is largely unknown.

OBJECTIVE: The aim of this study is to describe the organization and clinical practice for general palliative care in Danish hospitals and to explore the association between attitudes and clinical practice.

DESIGN: The study is a cross-sectional survey of hospital departments in Denmark with a partial comparison to a survey one decade earlier. Analyses were descriptive and logistic regression.

PARTICIPANTS: The questionnaire was sent to one randomly assigned chief of all 360 clinical hospital departments in Denmark.

KEY RESULTS: The response rate was 73%. Physical symptoms were addressed by 96% and spiritual problems by 56%. The proportion of departments that prioritized resources for general palliative care increased from 24% in 2013 to 51% in 2023. Assessment of needs for general and specialized palliative care was mostly based on a general appraisal. In multivariable logistic regression analyses, the medical departments were more likely to perform needs assessment than the surgical departments, and the attitude towards systematic needs assessment was associated with the clinical practice and planning end-of-life care in the department. The responsibility for planning end-of-life care was regarded as shared among several stakeholders.

CONCLUSIONS: General palliative care was focused on physical symptoms and assessment of target group and needs were rarely performed systematically despite national recommendations. Clinical practice was associated with specialty and attitudes.