Aims The majority of patients die in hospitals, yet care delivered to the dying in the acute setting is variable and the underlying reasons for this are not documented well. The authors aimed to explore healthcare professionals' views on the factors influencing good quality end-of-life (EOL) care in an acute hospital trust.

Methods Within a feasibility study examining the impact of a simple EOL care tool on the dying experience, the authors carried out qualitative interviews with healthcare professionals caring for dying patients.

Results Five focus groups, nine face-to-face and two ‘think aloud’ interviews were analysed using the framework approach. The emerging themes were difficulties in diagnosing dying (staff felt that the decision to switch to comfort care was often made late which meant that patients received unnecessary treatments); hospital culture (reluctance to withdraw active treatments; it was ‘brave’ to state a patient was dying); hospital systems (patients moved frequently between wards which did not facilitate diagnosing dying and medical notes did not provide sufficient information to aid junior doctors out of hours when making decisions about sick patients) and the impact of the EOL tool on care (nurses found the regular symptom scoring required by the tool helped them approach patients and families and give more appropriate care).

Conclusion This qualitative study has identified factors influencing care given to dying patients in an acute hospital setting. The authors suggest these factors need to be taken into account when trying to improve care for dying patients and in facilitating the use of EOL care pathways.