- Startseite
- Forschung
- Letzte Lebenszeit
- Dying in Hospital
- S3-Leitlinie - onkologisches Leitlinienprogramm
- Aktualisierung der S3-Leitlinie Palliativmedizin für Patienten mit einer nicht-heilbaren Krebserkrankung
- EUPCA - European Academy
- CoRe-WEB
- Oberstufenprojekt
- Externe Evaluierung der Palliativmedizinischen Tagesklinik am Klinikum Aschaffenburg-Alzenau
- Palliativmedizin in Pandemiezeiten (PallPan)
- ATPA
- AYACologne
- Studienregister
- Forschungsverbünde
Project Description
Hospitals are the most frequent place of death in Germany (47%), but at the same time, the least preferred one – for both patients and their relatives. Important indicators and outcome variables indexing quality of the dying phase and care for the dying are already consented. Moreover, there are already various proposals to achieve these quality objectives. However, they are still not sufficiently adapted to the heterogeneous needs and structures of individual hospital wards. Therefore, the planned three-phase project aims at the implementation and evaluation of situation-specific measures in everyday clinical practice.
Existing experience regarding optimum care of dying will be identified within the framework of an expert symposium and recorded within a portfolio of measures. Based on this, ten teams of different wards from two university hospitals select suitable measures and apply them in their daily clinical practice. The dying situation on the respective wards is recorded both at a baseline survey before application of the selected measures and afterwards in a follow-up survey. Retrospective file analysis of deceased persons, quantitative employee surveys, multi-professional focus groups and interviews with relatives form the data basis for his. Results are also to be checked for their transferability to other hospitals.
Optimisation of care in the terminal phase in hospitals
As part of the project ‘Dying in hospital – optimising care in the dying phase’ (StiK-OV), an approach was pursued to develop ward-specific measures in working groups (WGs) with ward staff. The measures are intended to contribute to optimising care in the dying phase in hospital wards outside specialised palliative care wards.
Below you will find information on the formation of working groups, tips on implementation and transfer to other hospitals, as well as templates and tips on developed measures.
The information is intended to help other hospitals design a similar process. The templates and tips on measures can be adapted and used to meet the needs of other hospitals/wards.
Formation of working groups
Three to six ward staff members should be recruited to form the multi-professional working groups. Recruitment can be carried out by the respective medical and nursing ward managers. In the StiK-OV project, the managers sent out a handout with information about the planned procedure via the relevant mailing lists and/or spoke to employees directly. The working groups were moderated with the support of the project team (scientists and individuals with palliative care expertise from various professional groups).
Implementation
The working groups should meet regularly (every 4-6 weeks) over a predefined period (e.g. 1 year). A structured approach is recommended for the development of measures in the working groups:
- Identification of challenges/areas for improvement
- Development of ward-specific measures
- Planning the implementation of measures
- Implementation of measures
Notes on implementation in other hospitals
The working group process must be adapted to the needs of the participants, especially the degree of structural and content-related involvement by the team. The identified hindering and facilitating factors can provide important assistance for the successful transfer of the approach to other hospital wards:
| Conducive factors | Impeding factors |
| Topic is relevant to the ward | Limited time and human resources |
Involvement of
| High turnover and declining participation |
| Multidisciplinary composition | Ward-specific dynamics/conflicts |
| Ideas and/or materials already available | Structural limitations (e.g. IT) |
| Mix: small, quickly implementable measures and larger measures that may require longer planning |
Management/ward level
Higher-level care standards for patients in the terminal phase have been developed, which include, for example, definitions of terms ("palliative", "dying") as well as medical and nursing measures. Information on the development of care standards can be found here.
Team level
At team level, case discussions were developed to improve communication. The aim was not only to strengthen the transfer of information and coordination, especially between doctors and nursing staff, but also to improve joint decision-making within the ward team. To this end, checklists were developed for the training process. Here you will find two templates for checklists (template 1 and template 2) and tips for conducting case discussions.
Level of care
To increase professional competence, training courses were offered on various topics, such as aromatherapy and oral care (for nursing staff), communication with patients in the terminal phase and their relatives, principles of care in the terminal phase, and palliative care structures. The aim was to strengthen the confidence of ward staff in their ability to care for patients and their relatives. The aim is to prevent stressful physical, psychosocial and spiritual symptoms. These should be identified and alleviated at an early stage, and measures that do not exclusively serve this purpose or that may place additional strain on those affected should be identified and discontinued. Here you will find information on creating and conducting training courses.
A flyer for relatives was developed to provide care for relatives after the death of the patient. The flyer contains condolences from the ward staff, information about what happens to the deceased, what relatives should/can do after the death, and possible sources of help, contact points and contact information. The aim is to support the ward team in caring for, informing and accompanying relatives. Here you will find a flyer template and information on how to create a flyer.
To support the ward team, a checklist was developed to inform relatives after the death of a patient. It contains information on how to inform relatives about the death, options for saying goodbye, procedures in cases of unexplained death, further steps (e.g. death certificate) and further care after saying goodbye. An internal contact list has been created for acute stress situations. Here you will find information on how to create a checklist and a template for an internal contact list.
Various pieces of furniture and decorative elements were used to redesign the farewell and patient rooms. The aim was to create a more personal and dignified environment for the dying process. Here you will find information and a list of materials for redesigning the space.
Recommendations have been formulated for more meaningful documentation of care in the dying phase, which you can download here. The goals were to improve the transfer of information and coordination within the ward team. A habits and resources sheet was developed to document the habits, preferences and resources of patients in the dying phase. Here you will find a template and instructions for use.
Information materials
Kremeike K, Ullrich A, Schulz H, Rosendahl C, Boström K, Kaur S, Oubaid N, Plathe-Ignatz C, Leminski C, Hower K, Pfaff H, Hellmich M, Oechsle K, Voltz R. Dying in hospital in Germany - optimising care in the dying phase: study protocol for a multi-centre bottom-up intervention on ward level. BMC Palliat Care. 2022 May 6;21(1):67. doi: 10.1186/s12904-022-00960-1. PMID: 35524257; PMCID: PMC9072764.
Oubaid N, Kaur S, Oechsle K, Ullrich A, Milke V, Schieferdecker A, Kremeike K, Meesters S, Herrmann C, Voltz R, Schulz H. Care for the Dying: A Scoping Review of Measures for Clinical Practice With Qualitative Synthesis. Omega (Westport). 2025 Mar 13:302228251322860. doi: 10.1177/00302228251322860. Epub ahead of print. PMID: 40078118.
Kaur S, Meesters S, Schieferdecker A, Dangendorf A, Strohbücker B, Oubaid N, Ullrich A, Milke V, Oechsle K, Schulz H, Voltz R, Kremeike K. How to Evaluate Hospital Care in the Dying Phase-Development of a Data Extraction Tool for Retrospective Medical Record Analysis. J Eval Clin Pract. 2025 Aug;31(5):e70174. doi: 10.1111/jep.70174. PMID: 40799077; PMCID: PMC12344475.
Meesters S, Schieferdecker A, Kaur S, Oubaid N, Ullrich A, Oechsle K, Schulz H, Voltz R, Kremeike K. Dying in hospital: a retrospective medical record analysis on care in the dying phase in intensive care units and general wards. Int J Qual Health Care. 2025 Apr 14;37(2):mzaf025. doi: 10.1093/intqhc/mzaf025. PMID: 40094993.
Oubaid N, Kaur S, Oechsle K, Milke V, Ullrich A, Schieferdecker A, Kremeike K, Meesters S, Herrmann C, Voltz R, Schulz H. How do healthcare professionals on non-palliative care wards perceive quality of care in the dying phase? Personal and organizational predictors identified in a cross-sectional study. PLoS One. 2025 Oct 31;20(10):e0334650. doi: 10.1371/journal.pone.0334650. PMID: 41171745; PMCID: PMC12578199.
Meesters S, Kaur S, Milke V, Herrmann C, Schieferdecker A, Oubaid N, Oechsle K, Schulz H, Pfaff H, Voltz R, Kremeike K. Formative evaluation of an employee-driven approach to improve care in the dying phase in hospitals. Palliat Support Care. 2025 Jul 18;23:e135. doi: 10.1017/S1478951525100400. PMID: 40676716.
Oubaid N, Kaur S, Milke V, Ullrich A, Schieferdecker A, Kremeike K, Meesters S, Herrmann C, Voltz R, Schulz H, Oechsle K. Healthcare Professionals' Perceived Burden Related to Care in the Dying Phase - Results of a Cross-Sectional Explorative Study on General Wards and Intensive Care Units. Omega (Westport). 2025 Jun 19:302228251353548. doi: 10.1177/00302228251353548. Epub ahead of print. PMID: 40536794.