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From concept to practice, is multidimensional care the leading principle in hospice care? An exploratory mixed method study
  1. Everlien de Graaf1,
  2. Merel van Klinken2,
  3. Danielle Zweers1 and
  4. Saskia Teunissen1
  1. 1 Julius Center for Health Sciences and Primary Care Department of General Practice, University Medical Center Utrecht, Utrecht, The Netherlands e.degraaf{at}
  2. 2 Department of Pain and Supportive Care, Netherlands Cancer Institute Anthoni van Leeuwenhoek, Amsterdam, The Netherlands
  1. Correspondence to Everlien de Graaf RN, Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands; e.degraaf{at}


Background Hospice care (HC) aims to optimise the quality of life of patients and their families by relief and prevention of multidimensional suffering. The aim of this study is to gain insight into multidimensional care (MC) provided to hospice inpatients by a multiprofessional team (MT) and identify facilitators, to ameliorate multidimensional HC.

Methods This exploratory mixed-method study with a sequential quantitative–qualitative design was conducted from January to December 2015. First a quantitative study of 36 patient records (12 hospices, 3 patient records/hospice) was performed. The outcomes were MC, clinical reasoning and assessment tools. Second, MC was qualitatively explored using semistructured focus group interviews with multiprofessional hospice teams. Both methods had equal priority and were integrated during analysis.

Results The physical dimension was most prevalent in daily care, reflecting the patients' primary expressed priority at admission and the nurses' and physicians' primary focus. The psychological, social and spiritual dimensions were less frequently described. Assessment tools were used systematically by 4/12 hospices. Facilitators identified were interdisciplinary collaboration, implemented methods of clinical reasoning and structures.

Conclusions MC is not always verifiable in patient records; however, it is experienced by hospice professionals. The level of MC varied between hospices. The use of assessment tools and a stepped skills approach for spiritual care are recommended and multidimensional assessment tools should be developed. Leadership and commitment of all members of the MT is needed to establish the integration of multidimensional symptom management and interdisciplinary collaboration as preconditions for integrated multidimensional HC.

  • Hospice care
  • Quality of life
  • Symptoms and symptom management
  • multidimensional care
  • interdisciplinary collaboration

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  • Contributors EdG, MvK and ST have made substantial contributions towards conception and design of the study. EdG and MvK performed the study. EdG, MvK, DZ and ST analysed the data. EdG, MvK, DZ and ST drafted the article. EdG MvK, DZ and ST approved the final version of the manuscript.

  • Competing interests None declared.

  • Ethics approval Medical ethical committee of the University Medical Center of Utrecht.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data used in this research article can be obtained from the research group.