Table 5 Qualitative analysis of free-text answers from specialized palliative care teams on ‘particularly well’ and ‘inadequately’ solved problems

Physical problems

61 (54.5)

19 (35.8)

Symptom control (general)

10 (8.9)

´Good symptom control at the end of life´

Pain

23 (20.5)

´Pain relief by PCA pump´

4 (7.5)

´Pain treatment; severe pain due to decubitus ulcer´

Dyspnea

11 (9.8)

´Dyspnea control´

1 (1.9)

´Dyspnea´

Gastrointestinal symptoms

2 (1.8)

´Significant reduction of fecal vomiting due to insertion of a nasogastric tube´

4 (7.5)

´Patient’s distress due to massive vomiting could not be alleviated by invasive mechanical solutions (placement of a drain tube) because of the patient’s non-compliance´

Agitation/restlessness

7 (6.3)

´Restlessness´

5 (9.4)

´Pronounced terminal agitation two nights before death, on-call staff reacted inadequately´

Other physical issues

3 (2.7)

´Wound care´, ´Preparations taken for the occurrence of bleedings were very good´

3 (7.5)

´Heavy mucous secretion´

Palliative sedation

5 (4.5)

´Symptom relief by palliative sedation´

2 (3.8)

´No agreement between patient and team regarding medication and sedation’

Psychosocial problems

25 (22.3)

10/53 (18.9)

Psychosocial care and emotional comfort

12 (10.7)

´Providing a sense of security´, ´Psychosocial support´

3 (5.7)

´The patient’s emotional reserve ´

Anxiety

6 (5.4)

´Attending to the patient’s future- and care-related fears´, ´Panic attacks due to breathlessness´

2 (3.8)

´Aiding the patient to be anxiety-free and relaxed´

Coping with the disease

4 (3.6)

´Patient’s acceptance of the situation´

4 (7.5)

´Patient denied disease-related discussions´

Autonomy/self-determination, wishes

6 (5.4)

´Autonomy was preserved´, ´Patient’s individual (care-related) needs and ideas were fully taken into account´

1 (1.9)

´Attention to patient perspective (wishes, experience) - limited communication because of time constraints’

Care-related problems

32 (28.6)

11 (20.8)

Dying at home or at the desired place of death

23 (20.5)

´Home death was made possible´

Care transitions

7 (6.3)

´Transfer to hospice prior to breakdown of the husband´

2 (3.8)

´Transfer to hospice did not take place´

Cooperation of involved services

4 (3.6)

´In cooperation with the nursing home staff, the patient received optimal care´

2 (3.8)

´No patient care attendant could be organized´

Terminal care

15 (13.4)

´Terminal care´

1 (1.9)

´Terminal phase recognized too late by part of the team´

General care issues

7 (13.2)

´No aids and appliances supplied, as the couple refused them´, ´Basic nursing – family caregivers approved a nursing service very late´

Family caregiver-related problems

15 (13.4)

18 (34.0)

Family caregiver care and counselling

36 (32.1)

´Support of the wife at home´, ´Family system preserved, husband was able to care until the end´

11 (20.8)

´Contact with family caregivers and counselling´

Difficult family dynamics

8 (15.1)

´Family caregivers conceptions of care often divergent from those of the patient´