From Hospital to Home: Interdisciplinary Approaches to Optimise Palliative Care Discharge Processes

Unseld M, Wnendt T, Sebesta C, van Oers J, Parizek J, Kum L, Masel EK, Mikula P, Heppner HJ, Zeilinger EL (2025)

Publication Type: Journal article

Publication year: 2025

Journal

International Journal of Environmental Research and Public Health MDPI

Book Volume: 22

Article Number: 1023

Journal Issue: 7

DOI: 10.3390/ijerph22071023

Abstract

The transition from hospital-based palliative care to home care is a critical phase often marked by logistical, medical, and emotional challenges. Effective discharge planning is essential to ensure continuity of care, yet gaps in communication, interdisciplinary coordination, and access to resources frequently hinder this process. This qualitative study explored key barriers, related support needs, and strategies for optimising palliative care discharge through semi-structured interviews with 28 participants, including healthcare professionals, recently discharged palliative care patients, and primary caregivers. Reflexive thematic analysis revealed five main themes: (1) discharge planning and coordination; (2) symptom management and medication; (3) psychosocial support; (4) communication and information; (5) the role of assistive devices and home care services. Discharge processes were often late or unstructured. Poor interdisciplinary collaboration and a lack of caregiver preparation also contributed to hospital readmissions and emotional distress. By focusing on needs, our analysis identifies not only what was lacking but also what is required to overcome these barriers. Our findings suggest that standardised discharge protocols and checklists, earlier planning, structured communication tools, and improved integration of home care services could enhance patient outcomes and reduce caregiver burden. Addressing psychosocial needs and ensuring timely access to assistive devices are also crucial. Strengthening interdisciplinary collaboration and refining discharge practices can facilitate smoother transitions and improve the quality of palliative care at home.

Authors with CRIS profile

Pavol Mikula Institut für Lehre und Forschung am Medizincampus Oberfranken (MCO) Hans Jürgen Heppner Medizinische Fakultät

Involved external institutions

Medizinische Universität Wien AT Austria (AT) Universität Wien / University of Vienna AT Austria (AT)

How to cite

APA:

Unseld, M., Wnendt, T., Sebesta, C., van Oers, J., Parizek, J., Kum, L.,... Zeilinger, E.L. (2025). From Hospital to Home: Interdisciplinary Approaches to Optimise Palliative Care Discharge Processes. International Journal of Environmental Research and Public Health, 22(7). https://doi.org/10.3390/ijerph22071023

MLA:

Unseld, Matthias, et al. "From Hospital to Home: Interdisciplinary Approaches to Optimise Palliative Care Discharge Processes." International Journal of Environmental Research and Public Health 22.7 (2025).

BibTeX: Download