German community pastors' contact with palliative care patients and collaboration with health care professionals.

The current level of palliative care in Germany is unsatisfactory. Health care professionals view the psychosocial support of patients and families and the collaboration amongst the different care providers as the main deficiencies. In this context little is known about the viewpoints of community pastors who might have an important role in providing psychosocial and spiritual care for patients at home. In order to study their perspectives we performed 76 standardized telephone interviews with Protestant and Catholic pastors and examined how much contact pastors had with palliative care patients; their views of the collaboration with health care professionals; and how the pastors assessed their own skills in palliative care. Forty-one percent of respondents had no contact with any palliative care patients. The majority perceived collaboration with family doctors to be insufficient. The pastors assessed their own skills concerning palliative care predominantly as "satisfactory". Our findings suggest that community pastors' participation in the delivery of palliative care in Germany might be encouraged by specialized training and intensified contact with health care professionals.

Discrepancies in the viewpoints of different German health care providers on palliative care.

In many countries with highly developed health care systems, significant improvements in end-of-life care are strongly recommended. Up to the present, the assessment of perceived deficits predominantly reflects the point of view of experts in the palliative and hospice movement, with very little being known about the perspective of other professionals. The aim of this study was to assess the points of view of a wide range of different health care providers who treated or interacted with palliative care patients. The authors subsequently performed 597 semistructured telephone interviews with a wide range of German health care professionals. Overall, the assessment of the current situation was better than expected, although statistically significant differences existed among the groups surveyed. However, there is an unquestionable need for improvement, although opinions regarding the extent of these deficits depend significantly on the individual respondents' roles and professional orientation.

[How does executive staff of home care nursing services estimate the situation of palliative care?]. / Wie schätzen leitende Mitarbeiter ambulanter Pflegedienste die Palliativversorgung ein?

Experts criticise heavily the current situation of palliative care in the home care setting in Germany. They claim that the education in palliative care of all involved professional groups should be improved and specialized services should be adjusted. Only few is known in this context about the perspectives and attitudes of nursing staff, who is significantly involved in palliative care. Therefore, interviews with executive stuff of home care nursing services in the Federal State of Brandenburg were performed in the context of an evaluative opinion survey. 88 of 100 planned interviews took place. The nursing services estimated the current situation predominantly good. This does not support the experts' opinions found in the literature. Nevertheless, the respondents saw serious needs for improvements, in particular concerning psycho-social issues. Although palliative patients numerically seem to be in the background of every day work life, great interest in further qualification and new concepts of care was shown. So far, only few home care nursing services employ palliative care-trained staff.

Hospital doctors' attitudes towards palliative care in Germany.

Experts from different areas strongly criticize the current level of palliative care in Germany, both inpatient and home care services. Apart from the experts' opinions, little is known in this context about the perspectives of hospital doctors working in different disciplines, such as surgery, internal medicine, gynaecology or anaesthesia. These doctors presumably treat many incurably ill patients with palliative care needs, but they usually have very little experience in palliative medicine. Their attitudes are particularly important because they are affected by the criticism and by future improvement strategies. To study their viewpoints, questionnaire surveys in five hospitals in the federal state of Brandenburg were performed, with 203 (69%) physicians participating. The results showed that the level of palliative care in hospitals was graded better than in the home care setting. Main needs for improvement were seen in the psychosocial support services and in the co-operation with outpatient services. In [corrected] the hospital physicians' view, palliative nursing care was of a higher standard than medical aspects [corrected] of care [corrected] The physicians showed great interest in improving their knowledge of [corrected] palliative care and in new specialist palliative care services. The conclusions were that three main strategies for improvement should be embarked on: (1) the establishment of integrated care systems to overcome financial and structural barriers between in- and outpatient care; (2) the establishment of further specialist palliative care services (eg, hospital-based palliative care teams); and (3) better education in palliative medicine.