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Strengthening palliative care in the hospital setting: a codesign study
  1. Claudia Virdun1,
  2. Tim Luckett1,
  3. Patricia M Davidson1,2 and
  4. Jane Phillips1
  1. 1IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), University of Technology Sydney, Sydney, New South Wales, Australia
  2. 2School of Nursing, Johns Hopkins University, Baltimore, Maryland, USA
  1. Correspondence to Claudia Virdun, IMPACCT (Improving Palliative, Aged and Chronic Care through Clinical Research and Translation), Faculty of Health, University of Technology Sydney Faculty of Health, Sydney, New South Wales, Australia; claudia.virdun{at}


Objective To identify actions required to strengthen the delivery of person and family centred hospital-based palliative care so that it addressed the domains of care identified as important for inpatients with palliative care needs and their families.

Methods A codesign study involving a workshop with palliative care and acute hospital policy, consumer and clinical representatives in Australia. A modified nominal group process generated a series of actions, which were thematically analysed and refined, before being circulated to participants to gain consensus.

Results More than half (n=30, 58%) of the invited representatives (n=52) participated in the codesign process. Nine actions were identified as required to strengthen inpatient palliative care provision being: (a) evidence-informed practice and national benchmarking; (b) funding reforms; (c) securing executive level support; (d) mandatory clinical and ancillary education; (e) fostering greater community awareness; (f) policy reviews of care of the dying; (g) better integration of advance care planning; (h) strengthen nursing leadership; and (i) develop communities of practice for improving palliative care.

Conclusions Changes to policy, practice, education and further research are required to optimise palliative care within hospital settings, in accordance with the domains inpatients with palliative care needs and their families consider to be important. Achieving these changes will require a whole of sector approach and significant national and jurisdictional leadership.

  • hospital care
  • terminal care
  • chronic conditions
  • service evaluation

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  • Contributors All authors contributed to the conceptualisation of this study and research protocol development. CV led the recruitment and preparations for the workshop. JP and CV cofacilitated the workshop itself. CV completed the initial data analysis prior to CV, TL and JP participating in consensus discussions and worked together to inform the final set of recommendations presented. All authors contributed to the writing of this manuscript. This research is supported by an Australian Government Research Training Programme Scholarship. This scholarship had no involvement in research design, conduct, manuscript preparation or choice of journal for submission.

  • Funding This study was funded by Australian Government Research Training Programme Scholarship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval was granted by St Vincent’s Hospital Sydney, Human Research Ethics Committee Ref. No. 2019/ETH03307 in October 2019.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. Additional data related to this study are available by contacting the corresponding author: