Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting
1
Social Work Department, The Sutherland Hospital, South Eastern Sydney Local Health District, Caringbah, NSW 2229, Australia
2
School of Social Sciences, University of Wollongong, Wollongong, NSW 2522, Australia
*
Author to whom correspondence should be addressed.
Hospitals 2025, 2(3), 15; https://doi.org/10.3390/hospitals2030015
Submission received: 27 May 2025
/
Revised: 26 June 2025
/
Accepted: 1 July 2025
/
Published: 3 July 2025
Abstract
The majority of Australians who die each year do so in an acute hospital setting and are cared for during the end of their life by a multidisciplinary team comprising nurses, medical staff, and allied health staff. Despite the range of professional disciplines that services this patient group, the experiences of the staff providing this end-of-life care is not well understood. This study sought to explore the experiences of multidisciplinary staff providing this care at an acute hospital in Sydney, Australia and to identify the barriers that affect the end-of-life care provided. Data were collected through an online survey from a multidisciplinary sample group. A combination of statistical analysis and thematic analysis was used to analyse the data with four key themes emerging. These themes included the implications for staff working in end-of-life care, communication gaps in the acute hospital setting, recognition of the dying process, and improvement of end-of-life care through further education. This study highlighted the challenges experienced by healthcare staff in the end-of-life context, with recommendations provided for increased education and training. The need for staff to receive training with a focus on end-of-life skill development, professional confidence, and preparedness for end-of-life conversations was highlighted.
1. Introduction
This study investigated the experience of staff working in end-of-life care in the acute setting of The Sutherland Hospital, in Sydney, Australia. In 2014, 50% of deaths in Australia occurred in a hospital, highlighting the prevalence of end-of-life care in the acute hospital setting [1]. However irrespective of this, there has been limited investigation into the experience of staff providing this care. This, in turn, has resulted in a lack of understanding of factors that impact the delivery of care for both healthcare staff and patients [2]. At The Sutherland Hospital, there are approximately 400 deaths annually on the acute wards. The acute wards include the medical specialties of oncology, neurology, cardiology, and respiratory, as well as paediatrics, surgical, orthopaedic, gastroenterology, general medicine, and an Intensive Care Unit. Staff who work across these wards include nurses, doctors, social workers, occupational therapists, physiotherapists, etc., all of whom have varying training and experience in providing end-of-life care. Despite this difference in training and experience, the expectation for multidisciplinary teams in the healthcare provision is that they work together. The purpose of this study was to understand the impact of end-of-life care on hospital ward staff across a range of disciplinary groupings and how it has the potential to influence the quality of care provided, as well as individual staff wellbeing.
Healthcare staff working in end-of-life care in an acute hospital setting have reported emotional and mental health stressors associated with working with end-of-life patients. The facilitation of discussions about end-of-life and post-death care has been described by clinicians as confronting and having an impact on their emotional wellbeing [3]. This impact on staff has led to a conflict between both personal and professional values, compromising their ability to provide optimal care [4]. Given the high percentage of deaths that occur in Australian hospitals each year, it is important to understand the impact on the multidisciplinary staff working in acute hospital settings, as they are essential in providing collaborative and effective end-of life care [5,6,7]. Healthcare staff have reported that effective communication and a collaborative approach would meet the needs of patients and families within palliative care, as well as improve the emotional wellbeing of staff when working in emotionally difficult situations [8,9]. It has been reported that this group of staff finds it increasingly difficult to work within the field of end-of-life care due to the emotional stress when caring for an individual in their dying days, as well as the pressure of time constraints and ineffective communication between staff and patients and their families [4,8]. Identifying the need for organisational support measures within an acute hospital setting allows staff to develop strong coping skills that are significant to managing emotional stress [10]. Given that the organisational and environmental context in which end-of-life care is provided differs between acute hospitals, it is useful to evaluate the needs of specific healthcare staffing populations to target strategies to support this workforce.
The current literature argues that, at the end of an individual’s life, the quality of end-of-life care can be improved through honest conversations with staff about the individual and their loved ones’ needs [2]. Focusing on honouring the wishes and needs of the patient within these conversations will allow the individual to avoid “unnecessary treatments in the final days of life, unmet needs and family stresses associated with providing care” [11]. Currently, there is limited education within university curricula on how healthcare professions such as doctors [12], nurses [13], and social workers [14] approach end-of-life care conversations. This has implications for healthcare workers finishing their studies, as they are underprepared to care for the dying and grieving families due to a lack of education and training [14].
In addition, the literature identifies a recurring theme in the emotional impact of ineffective communication on staff wellbeing, where staff feel that time constraints and uncertainty about a patient’s prognosis act as barriers to communicating the end-of-life care process to patients’ and their families [8,15]. Discussing the process of how a person’s life will end is emotionally confronting. These barriers have an impact on individual and collective staff wellbeing; without peer support and collaboration, it ultimately leads to burnout and emotional stress [3,15]. This is particularly felt in times of end-of-life decision making, whereby multidisciplinary communication is paramount to patient care [16].
Nurses [7], social workers [14], and doctors [17] have expressed that there is a current gap regarding a lack of consistent training and education when providing end-of-life care with ramifications associated with symptom management and family communication. Furthermore, nurses and doctors feel they are not prepared to have confronting conversations regarding the end-of-life care process and, therefore, require further training to improve the quality of care and support they are able to provide [17]. Healthcare professionals have articulated difficulty in responding to families emotionally, which can result in failing to effectively recognise their grief [2]. This is a significant barrier to communication for staff, where healthcare workers feel unable to engage in compassionate conversations due to a lack of communication training [18,19]. Research has established that those experiencing end-of-life care benefit from early conversations about the resuscitation plan, medical treatments, and interventions to actively prepare for the end of life [15]. A lack of preparedness for end-of-life conversations has created a significant gap within research and care, where these honest conversations about the end-of-life experience do not occur early enough and, therefore, have a negative impact on both the staff and the individual [10,18].
2. Materials and Methods
This study was undertaken at The Sutherland Hospital, located in Sydney, Australia, in 2023. This hospital provides acute inpatient services to approximately 230,000 residents of the local community. The hospital’s emergency department manages over 50,000 patients annually, supported by approximately 375 inpatient beds. The local area in which the hospital is situated has 43,230 residents aged 65 and over and is home to significant populations of English, Irish, Australian, and Italian backgrounds. This study site was chosen due to its acute care service provision and the ageing population it services.
Data were gathered using the ‘End-of-Life Care Audit Toolkit’, a validated clinicians’ survey that was developed by The Australian Commission on Safety and Quality in Health Care to assist health service organisations in improving the quality of their end-of-life care [20]. The clinicians’ survey was adapted to (1) fit the sample group profile, including updating demographic questions to align with current community values on gender identity and modifying it to reflect mortality rates on wards identified as regularly providing end of life care, including aged care (or older adult care), oncology, cardiology, respiratory, and neurology; (2) include a list of identified staff disciplinary groupings on acute care wards; and (3) exclude crisis wards like the emergency department, coronary care unit, and intensive care unit due to the crisis nature of care in these areas.
The original survey consisted of 30 multiple choice questions using Likert scales to measure participants’ answers in an ordinal format [21]. An additional qualitative open-ended text question was added to allow for descriptive responses (please see Table 1 for full survey questions). Solely relying on statistical analysis would have limited a comprehensive understanding of the data and made it difficult to interpret the significance of the entire dataset. Across healthcare research, a mix of quantitative and qualitative approaches has emerged as a suitable methodology to answer broad and complex questions [22,23]. Ethics approval was granted by South Eastern Sydney Local Health District HREC, approval 2022/ETH02601.
Probability sampling was adopted through a random selection process. However, for inclusion, participants were required to be over eighteen years of age, permanently employed in one of the identified disciplinary groupings, and working on one of the following wards: aged care, oncology, neurology, cardiology, or respiratory wards. Participants excluded from the study were those who volunteered at the hospital, worked casually, or who worked in wards outside the identified specialties. A research advisory group comprising healthcare clinicians was formed to assist the study through participant recruitment, the co-design of the data collection tool, and the co-analysis of aggregated data.
The recruitment strategy for the study included the following three approaches: (1) flyers advertising the research and outlining the research design and participant information were placed in informal areas around The Sutherland Hospital on the identified wards, such as tea rooms and staff-only areas; (2) the research team attended multidisciplinary team ward meetings to promote the study; (3) the research team and advisory group discussed the aim of the research with key stakeholders at The Sutherland Hospital, such as nurse unit managers, medical directors, and heads of departments, to promote participation. The survey was made available to participants online through the Qualtrics platform, with no incentives provided for participation.
Data Analysis
To analyse the 31 questions, a combination of statistical analysis and thematic analysis was used. Descriptive statistical analysis was chosen for its effectiveness in establishing central tendency and summarising categorical data [24]; thus, both descriptive and inferential statistical analyses of questions 1–30 were undertaken, beginning with the development of descriptive and frequency tables. Each question from the survey was interpreted and analysed in turn, with the researcher making note of key discrepancies and observations. Thematic analysis was used to analyse the data gathered from the added qualitative question (question 31). This involved initial identification of themes and sub-themes, with text responses being coded to connect similar answers into groups, allowing for the discovery of recurring patterns within the data [25,26].
Following statistical analysis and thematic analysis, a final layer of co-analysis was used to draw together the findings from both the quantitative and qualitative responses and to integrate the voices of the research advisory group. At this stage in the data analysis, the de-identified and aggregated datasets were presented to the advisory group to develop a further layer of meaning-making through discussions about the predominant themes, contextual factors, and transferability of the findings [27,28]. The reflections from members of the advisory group allowed for an increased understanding of end-of-life care in the acute hospital context.
3. Results
The total healthcare staff population of The Sutherland Hospital was 280, and 70 online surveys were completed, providing a response rate of 25%. The majority of participants self-identified as being from nursing (27.5%), followed by social work (17.4%), occupational therapy (14.5%), junior doctors (13%), physiotherapy (11.6%), and dietetics (7.2%) (see Table 2).
The identified clinical areas of the participants included aged care (67.2%), cardiology (11.9%), respiratory (11.9%), and oncology and neurology (9%). The majority of participants had 2–5 years of experience working in a hospital setting (n = 27, 38.6%), with the second largest group being professionals with >10 years of experience (n = 18, 25.7%).
The following four primary themes were identified as impacting end-of-life care in the acute hospital setting: (1) the implications for staff working in end-of-life care; (2) communication gaps in an acute hospital setting; (3) recognition of dying; and (4) improving end-of-life care through further education.
3.1. Implications for Staff Working in End-of-Life Care
3.1.1. Confidence of Healthcare Staff
Participants were asked to assess their confidence in recognising when a patient is dying. The majority indicated that they felt confident in their skill level (n = 51, 72.8%), while 27.2% (n = 19) of participants reported lacking confidence. Among those who felt less confident, the largest group had 0–5 years of clinical experience. Overall, 27.1% (n = 19) of participants identified as “not confident” and 72.9% (n = 51) as “confident” in their abilities (see Table 3).
Participants were then asked whether they felt confident in other professionals’ knowledge and skills to recognise when a patient is dying, their preparedness for end-of-life conversations, and the timing of decisions made on their ward. After conducting an inferential analysis, confidence in senior nurses was significantly higher compared to junior doctors (<0.001), junior nurses (<0.001), and allied health professionals (<0.001). With the results for senior nurses being below 0.005 and a positive number, these tables demonstrate that, when comparing senior nurses to other professional disciplines, the confidence in senior nurses is significantly higher.
Personal distress when working in end-of-life care impacts an individual’s confidence, wellbeing, and capacity for communication. When participants were asked about their personal experience working in end-of-life care, 71.4% of participants working in the acute hospital setting reported feeling distressed sometimes (n = 37), usually (n = 7), or always (n = 6).
3.1.2. Timing of Decisions About End-of-Life Care
The majority of participants identified medical consultants as the primary decision makers in end-of-life care (n = 40, 57.1%), and a small percentage identified junior doctors as the decision makers (n = 7, 10%). The data demonstrate that confidence in timely decision making of the medical discipline is intermediate, with 57.9% (n = 40) of participants identifying as feeling confident in consultants and 39.7% (n = 27) of participants feeling confident in junior doctors (see Table 4).
3.2. Communication Gaps in an Acute Hospital Setting
3.2.1. Preparedness for End-of-Life Conversations
A theme that emerged from the data was participants’ preparedness to have end-of-life conversations with both patients and their families. A considerable proportion of participants (n = 43, 61.4%) stated that engaging in conversations with patients and their families about death and dying is part of their role as healthcare professionals. Social workers (17.4%) and nurses (21.4%) were identified as communicating the most with patients and families during end-of-life care. The majority of participants across disciplines (n = 40, 60.6%) indicated confidence in their ability to have end-of-life conversations. Conversely, 39.4% (n = 26) of participants indicated a lack of confidence in their capacity to engage in these conversations.
3.2.2. Communication Within Multi-Disciplinary Teams
A prominent theme that emerged was the need for increased communication, with a clear desire for collaboration between professional disciplines. As one participant requested, “more holistic intervention and collaboration from disciplines” (Participant 19). Consultants and junior doctors were identified by the participants as the primary decision makers in end-of-life care. However, the fast-paced environment of a hospital was highlighted as affecting patient prioritisation. One participant elaborated on the following:
It feels as if medical officers are not receptive to input regarding possibly requiring palliative care they usually write down “patient is for palliative care input” or for “comfort measures”, and no real plan in place. As if [they are] waiting for the patient to deteriorate fully until end-of-life care is the only option left (Participant 17).
Participants consistently expressed the importance of interdisciplinary communication and adopting an approach that encourages staff collaboration and prioritises timely end-of-life care.
3.3. Recognition of Dying
While participants were previously asked to comment on their confidence in their own and others’ ability to recognise when a patient is dying, in this theme, participants were asked to comment on the perception of ability in themselves and others. Recognition of dying is integral to providing end-of-life care and pain management in a timely manner, ultimately affecting the quality of care provided. Participants were asked whether they felt that the various disciplines who work on the acute wards are skilled at recognising when a patient is dying. The findings suggest strong confidence in the ability of senior nurses and a lack of confidence in the ability of junior-level staff across disciplines. This may be due to limited exposure to end-of-life care among some junior staff.
Participants were asked to report on their skill level in relation to ‘recognition of dying’ and ‘preparedness of having end-of-life conversations’. When comparing the responses, health care staff reported having stronger skills in recognising when a patient is dying, as opposed to speaking with patients and their families about the dying process (Ptukey= 0.012) (see Table 5).
As one participant stated, there is a need to be “more proactive in starting discussions with patient/family early and ensuring specific staff are allocated to ensure [palliative] care recommendations are being carried out” (Participant 1).
3.4. Improving End-of-Life Care Through Further Education
3.4.1. Need for Further Training/Education
A recurring theme expressed by participants was the need for further education to provide high-quality end-of-life care and thereby reduce workplace stress. Participants were asked to evaluate the quality of end-of-life care on their ward, which required healthcare staff to make a judgement based on their experience working in the acute hospital. Although the responses were skewed positively at 78.5% (n = 55), 21.4% (n = 15) of participants selected that end-of-life care was done well on their ward sometimes or rarely. These findings suggest a lack of confidence among staff in the end-of-life care being provided.
Participants were asked to nominate which aspects of end-of-life care they had received formal education in, including recognising when a patient is dying and how to communicate with patients and their loved ones. The findings suggest that a minority of staff (10.1%, n = 7) had received training in one of these areas only. As one participant stated, the improvement of end-of-life care requires, “better education to staff on recognising dying patients and caring for them” (Participant 21). This same participant also requested, “education on how we can talk to families of dying patients and the patients” (Participant 21), indicating that they had received neither. This request was echoed by several participants, including Participant 12, stating there is a need for “more education to recognise signs of dying and what to do”.
3.4.2. Palliative Care Involvement
Participants were asked how often the palliative care team is consulted in end-of-life care on their ward and whether they would like to contact palliative care earlier in the dying process. The majority of participants (n = 57, 80.4%) identified that the palliative care team is involved in end-of-life care either “always” or “usually”. In contrast, 18.6% of staff identified that the palliative care team is only consulted “sometimes” (n = 11) or rarely (n = 2) in their experience. A substantial proportion of participants (n = 52, 83.9%), stated they would like to call the palliative care team earlier.
4. Discussion
4.1. Challenges Facing Healthcare Staff
It is already established that working in end-of-life care is emotionally challenging, influenced by factors such as the urgency of decisions, whether a death was expected, respect for patient wishes, and interdisciplinary dynamics [29,30]. These challenges can lead to compassion fatigue, affecting the quality of care provided to patients and families [15,31]. The literature highlights that confidence in providing quality end-of-life care is closely tied to healthcare professionals’ experience and knowledge, with a lack of exposure increasing emotional distress [12,32].
Consistent with the findings of this study, the literature highlights a lack of education in end-of-life care within tertiary environments for social workers, doctors, and nurses, particularly in recognising dying and preparedness for emotionally challenging conversations [12,13,14]. Time constraints in a hospital environment have a substantial impact on healthcare staff and their ability to make timely decisions for patients experiencing end-of-life care. The findings highlighted how the timing of decisions has an impact on the collaboration and communication within a multi-disciplinary team and, therefore, impacts the care provided to both patients and families. Participants identified a lack of confidence in the timing of decisions made and a need for further staff to prioritise end-of-life care patients. Due to time constraints when working in urgent and critical hospital settings [33], palliative care as a form of intervention is not often prioritised, and healthcare professionals feel they are not able to provide quality end-of-life care [34]. Additionally, time constraints can make it difficult to have comprehensive discussions regarding a patient’s preferences and options for care [35]. Across different hospital contexts, healthcare professionals have a high workload, which impacts whether they are able to recognise when a patient is dying and, therefore, the ability to make timely decisions regarding interventions or the need for palliative care [34]. As highlighted in the findings, time constraints significantly impact the distress experienced by patients, families, and healthcare professionals to make informed decisions [36]. Given that the findings contextualise the lack of confidence as primarily from participants early in their careers, this has implications for the orientation of and support for staff entering the hospital workplace environment and new clinical areas in end-of-life care.
4.2. Challenges and Opportunities for Multidisciplinary Care
Communication is both a challenge and an opportunity for a multidisciplinary team providing end-of-life care. Communication is a significant aspect of providing care to patients who are dying and their families [7,37]. Communication between multidisciplinary team members, patients, and families is essential to develop a holistic perspective to patient-centred care [15]. Within The Sutherland Hospital, participants identified a need for holistic interventions through increased multidisciplinary collaboration and communication to improve the quality of care offered. Poor communication between a multidisciplinary team and patients can lead to moral distress due to the inability to provide care based on the patient’s end-of-life wishes [31]. Communication in an end-of-life capacity allows for the preferences of the patient and their families to be integrated, as well as ensuring a focus on delivering person-centred care consistently [37,38]. Participants were asked to articulate how end-of-life care could be improved based on their experiences working at The Sutherland Hospital. A substantial number of participants discussed improving the timeliness of medical decisions through shared communication with the multidisciplinary team, families, and, most importantly, the patient.
Recognising when a patient is dying is crucial for developing a care plan focused on comfort rather than curative treatment [36,39]. However, challenges such as the unpredictability of end-of-life symptoms and fluctuating medical conditions can impede timely recognition, leading to unnecessary interventions and delayed comfort measures [34,39]. In addition, time constraints in busy acute hospital environments significantly affect healthcare staff’s ability to make timely decisions for end-of-life care, often leading to poor collaboration within multi-disciplinary teams and reduced quality of care for patients and families [33,34]. As evident in this study, this also hinders comprehensive discussions about patient preferences, increases distress among patients, families, and professionals, and contributes to a lack of confidence in decision making [35,36].
Within acute Australian hospitals, the recognition of dying is documented within the last days of a person’s life, and thus, patients continue to receive curative treatment until then rather than comfort measures [36]. The early recognition of dying can reduce unnecessary interventions that prolong suffering and offer time for the patient and their family to make informed decisions [39]. However, there are limitations regarding a professional’s ability to recognise when a patient is dying, which include uncertainty in predicting when someone is on an end-of-life pathway, as each individual experiences symptoms differently [39], and fluctuations in a patient’s medical condition can impact this medical decision [34]. The literature emphasises that the communication and recognition of dying are essential to providing quality care at the end of life.
Despite the majority of participants identifying their confidence in having end-of-life conversations, there is a portion of participants who identified as not feeling confident in their ability. The reason for a lack of confidence could be attributed to the disciplinary scope of practice. For example, social workers have the requisite knowledge and skills to provide emotional support for patients and families, whereas doctors or nurses, coming from a medical viewpoint, may be more likely to recognise when a patient is physically dying compared to their social work counterpart. These roles are established through the nature of interdisciplinary work in acute hospitals [40].
Palliative care was emphasised in the findings as being a source of comfort for staff in their capacity to respond to a patient’s needs at the end of their life. Palliative care involvement is often necessary at the end of life to support symptom management, implement comfort measures, and improve quality of life [41,42]. The findings in this study demonstrated high involvement by the local palliative care team. However, participants expressed a need to contact the palliative care team earlier to address the needs of patients experiencing end-of-life care. This is likely due to the holistic approach to the dying process, which is inherent in palliative care provision. Despite this, palliative care cannot be the only source of strong multidisciplinary communication surrounding patient care [35]. Poor communication can lead to staff moral distress and prevent the provision of care that is aligned with the patient’s end-of-life wishes, while timely and shared decision making enhances patient care [31,38].
4.3. Improving Quality of Care Through Education
Finally, the findings identified that a large portion of The Sutherland Hospital staff had not received formal education regarding how to care for dying patients, how to recognise when patients are dying, or how to communicate with patients and their families. Some participants stated that they had received education on either recognition of dying or communicating, rather than both areas. Training provided to healthcare staff on the physical, social, and emotional needs of patients has proven to increase preparedness, confidence, and effective delivery of end-of-life care [10]. The National Palliative Care Standards, including assessment of needs, providing care, grief support, and quality improvement, all recognise the importance of continued training to be responsive, provide specialised care, communicate effectively, and apply relevant models of care [43].
Medical and allied health professionals working in a critical care setting can experience a lack of support, which impacts the support they are able to offer to patients and families experiencing end-of-life care [33]. As professionals, their own emotions are concealed due to the fast-paced nature of working in a hospital. Professional education dedicated to preparing healthcare staff for end-of-life care would alleviate uncertainty around how and when to provide care. Ongoing training and education for health professionals is crucial in enhancing patient care, alleviating staff distress, and improving their ability to provide comprehensive support [17,44]. In addition, training provided to healthcare staff on the physical, social, and emotional needs of patients has proven to increase preparedness, confidence, and effective delivery of end-of-life care [10].
4.4. Limitations to the Study
Given the relatively low response rate (25%), the results cannot be generalised to the greater hospital staffing population. However, our data offer valuable insights into end-of-life care experiences among diverse healthcare professionals in Australian hospitals. In addition, information regarding the research was only distributed during the day, and therefore further research would benefit from capturing the experiences of night-time staff working in end-of-life care. There were additional limitations present in the data collection tool itself. Namely, the survey did not distinguish what is meant by ‘distress’ and did not identify what ‘recognising when a patient is dying’ means. This allowed for interpretation on the part of participants and may have skewed these results. Finally, staff who worked on wards such as the Emergency Department, the Coronary Care Unit, and the Intensive Care Unit were excluded from the study. While the rationale for this exclusion was that, in crisis clinical areas, deaths are often expected and traumatic, with the end-of-life care provided by staff being more short-term and responsive in nature [45], it is also recognised that this exclusion may have omitted key perspectives on end-of-life care more broadly throughout the hospital setting.
For these reasons, it is recommended that qualitative data collection be undertaken to develop further context into this experience. This would allow for richer insights into the complexities of providing end-of-life care and contribute to the improvement of care through an understanding of staff experiences.
5. Conclusions
This study aimed to explore the experience of multidisciplinary staff that provide end-of-life care in an acute hospital context. Overall, the findings have highlighted the various aspects of end-of-life care that impact the experience for healthcare staff and patients. The timing of decisions made by healthcare professionals undoubtedly plays a role in ensuring that patients receive appropriate care relevant to their identified preferences. However, the findings also suggested that a lack of confidence in the timing of decisions made impacts that overall experience.
To support the multi-disciplinary team, an increase in the involvement of palliative care in the earlier stages of end-of-life care was suggested as a helpful addition in allowing for a focus on early symptom management and quality of life for the patient. This would then allow for the prioritisation of the early development of a care plan alongside patients, families, and medical providers.
Working within the end-of-life care space requires empathy, resilience, and compassion. Healthcare staff have a significant role in ensuring that patients and families are receiving quality care, emotional support, and most importantly, dignity throughout the patient’s journey. Working within end-of-life care can be distressing and emotionally confronting, and therefore, the importance of continuous education and multidisciplinary communication and staff support is certain to enhance this experience for both patients and staff. Timely decision making, effective communication within a multidisciplinary team, and palliative care principles are all necessary to provide cohesive and comprehensive support. Additionally, all of these aspects of care can support healthcare professionals working in this context to reduce burnout and foster a collaborative healthcare environment.
Finally, this study found that improving staff confidence in end-of-life care requires increased specialist training and further education in the two key areas of recognising when a patient is dying and preparing staff for end-of-life conversations. Through increasing staff education, the capacity for earlier identification of patient needs when approaching end-of-life can occur, decreasing patients’, families’, and staff’s feelings of distress and discomfort through appropriate intervention, such as palliative care involvement. Adding to this, early recognition also allows for timely decisions to be made by the multidisciplinary team, supporting a holistic approach to end-of-life care in the acute hospital setting.
Author Contributions
Conceptualisation, J.M. and M.F.; Methodology, J.M. and M.F.; Investigation, M.W.; Formal Analysis, M.W.; Writing-Original Draft Preparation, M.W.; Writing- Review & Editing, J.M. and M.F., Supervision, J.M. and M.F. All authors have read and agreed to the published version of the manuscript.
Funding
This research received no external funding.
Institutional Review Board Statement
Ethics approval was granted by South Eastern Sydney Local Health District HREC, approval 2022/ETH02601 (approved date 20 February 2023).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
The raw data supporting the conclusions of this article will be made available by the authors upon request.
Conflicts of Interest
The authors declare no conflicts of interest.
References
- Australian Institute of Health and Welfare. Deaths in Australia. Available online: https://www.aihw.gov.au/reports/life-expectancy-death/deaths-in-australia/contents/summary (accessed on 20 September 2024).
- MacKenzie, A.; Lasota, M. Bringing life to death: The need for honest, compassionate, and effective end of life conversations. Natl. Libr. Med. 2020, 40, 476–484. [Google Scholar] [CrossRef] [PubMed]
- Muskat, B.; Brownstone, D.; Greenblatt, A. The experiences of pediatric social workers providing end-of-life care. Soc. Work Health Care 2017, 56, 505–523. [Google Scholar] [CrossRef] [PubMed]
- Willard, C.; Luker, K. Challenges to end of life care in the acute hospital setting. Palliat. Med. 2006, 20, 611–615. [Google Scholar] [CrossRef]
- Australian Bureau of Statistics. Classifying Place of Death in Australian Mortality Statistics. Available online: https://www.abs.gov.au/statistics/research/classifying-place-death-australian-mortality-statistics (accessed on 20 September 2024).
- Rawlings, D.; Yin, H.; Devery, K.; Morgan, D.; Tieman, J. End-of-life care in acute hospitals: Practice change reported by health professionals following online education. Healthcare 2020, 8, 254. [Google Scholar] [CrossRef]
- White, K.R.; Coyne, P.J. Nurses’ perceptions of educational gaps in delivering end-of-life care. Oncol. Nurs. Forum 2011, 38, 711–717. [Google Scholar] [CrossRef]
- Frey, R.; Gott, M.; Raphael, D.; O’Callaghan, A.; Robinson, J.; Boyd, M.; Laking, G.; Manson, L.; Snow, B. Clinical staff perceptions of palliative care-related quality of care, service access, education and training needs and delivery confidence in an acute hospital setting. BMJ Support. Palliat. Care 2014, 4, 381–389. [Google Scholar] [CrossRef]
- Muskat, B.; Greenblatt, A.; Anthony, S.; Beaune, L.; Hubley, P.; Newman, C.; Brownstone, D.; Rapoport, A. The experiences of physicians, nurses, and social workers providing end-of-life care in a pediatric acute-care hospital. Death Stud. 2020, 44, 105–116. [Google Scholar] [CrossRef] [PubMed]
- Shushtari, S.G.; Molavynejad, S.; Adineh, M.; Savaie, M.; Sharhani, A. Effect of end-of-life nursing education on the knowledge and performance of nurses in the intensive care unit: A quasi-experimental study. BMC Nurs. 2022, 21, 102. [Google Scholar] [CrossRef]
- Zadeh, R.S.; Eshelman, P.; Setla, J.; Sadatsafavi, H. Strategies to improve quality of life at the end of life: Interdisciplinary team perspectives. Am. J. Hosp. Palliat. Med. 2018, 35, 411–416. [Google Scholar] [CrossRef]
- Pereira, J.; Meadows, L.; Kljujic, D.; Strudsholm, T.; Parsons, H.; Riordan, B.; Faulkner, J.; Fisher, K. Learner experiences matter in interprofessional palliative care education: A mixed methods study. J. Pain Symptom Manag. 2022, 63, 698–710. [Google Scholar] [CrossRef]
- McCourt, R.; Power, J.J.; Glackin, M. General nurses’ experiences of end-of-life care in the acute hospital setting: A literature review. Int. J. Palliat. Nurs. 2013, 19, 510–516. [Google Scholar] [CrossRef]
- Dewar, S.; Mensinga, J.; Redman, M.; Johns, L. A qualitative interpretive meta-synthesis of social workers’ experience in end-of-life care. J. Soc. Work 2023, 23, 280–299. [Google Scholar] [CrossRef]
- Hillman, K.M.; Cardona-Morrell, M. The ten barriers to appropriate management of patients at the end of their life. Intensive Care Med. 2015, 41, 1700–1702. [Google Scholar] [CrossRef]
- Mayers, T.; Kashiwagi, S.; Mathis, B.J.; Kawabe, M.; Gallagher, J.; Morales Aliaga, M.L.; Donners, K.; Matsuzawa, K.; Tsuru, T.; Nakano, H.; et al. International review of national-level guidelines on end-of-life care with focus on the withholding and withdrawing of artificial nutrition and hydration. Geriatr. Gerontol. Int. 2019, 19, 847–853. [Google Scholar] [CrossRef]
- Suikkala, A.; Tohmola, A.; Rahko, E.K.; Hökkä, M. Future palliative competence needs—A qualitative study of physicians’ and registered nurses’ views. BMC Med. Educ. 2022, 21, 585. [Google Scholar] [CrossRef]
- Anderson, R.J.; Bloch, S.; Armstrong, M.; Stone, P.C.; Low, J.T. Communication between healthcare professionals and relatives of patients approaching the end-of-life: A systematic review of qualitative evidence. Palliat. Med. 2019, 33, 926–941. [Google Scholar] [CrossRef]
- Hussin, E.O.D.; Wong, L.P.; Chong, M.C.; Subramanian, P. Nurses’ perceptions of barriers and facilitators and their associations with the quality of end-of-life care. J. Clin. Nurs. 2018, 27, 688–702. [Google Scholar]
- Australian Commission on Safety and Quality in Health Care. End-of-Life Care. Available online: https://www.safetyandquality.gov.au/our-work/end-life-care (accessed on 27 September 2024).
- Sullivan, G.M.; Artino, A.R., Jr. Analyzing and interpreting data from Likert-type scales. J. Grad. Med. Educ. 2013, 5, 541–542. [Google Scholar] [CrossRef]
- Walter, M. Social Research Methods; Oxford University Press: Oxford, UK, 2020. [Google Scholar]
- Braun, V.; Clarke, V. Thematic analysis. In APA Handbook of Research Methods in Psychology: Vol. 2. Research Designs; Cooper, H., Ed.; APA Books: Washington, DC, USA, 2019; pp. 57–71. [Google Scholar]
- Ozuem, W.; Willis, M.; Howell, K. Thematic analysis without paradox: Sensemaking and context. Qual. Mark. Res. 2022, 25, 143–157. [Google Scholar] [CrossRef]
- Nierse, C.J.; Schipper, K.; van Zadelhoff, E.; van de Griendt, J.; Abma, T.A. Collaboration and co-ownership in research: Dynamics and dialogues between patient research partners and professional researchers in a research team. Health Expect. 2012, 15, 242–254. [Google Scholar] [CrossRef]
- Tracy, S.J. Qualitative quality: Eight “big-tent” criteria for excellent qualitative research. Qual. Inq. 2010, 16, 837–851. [Google Scholar] [CrossRef]
- van Gaans, D.; Erny-Albrecht, K.; Tieman, J. Palliative care within the primary health care setting in Australia: A scoping review. Public Health Rev. 2022, 43, 1604856. [Google Scholar] [CrossRef]
- Ledger, U.S.; Reid, J.; Begley, A.; Dodek, P.; McAuley, D.F.; Prior, L.; Blackwood, B. Moral distress in end-of-life decisions: A qualitative study of intensive care physicians. J. Crit. Care 2021, 62, 185–189. [Google Scholar] [CrossRef]
- De Brasi, E.L.; Giannetta, N.; Ercolani, S.; Gandini, E.L.M.; Moranda, D.; Villa, G.; Manara, D.F. Nurses’ moral distress in end-of-life care: A qualitative study. Nurs. Ethics 2021, 28, 614–627. [Google Scholar] [CrossRef]
- Saunders, R.; Glass, C.; Seaman, K.; Gullick, K.; Andrew, J.; Wilkinson, A.; Davray, A. Clinical staff perceptions on the quality of end-of-life care in an Australian acute private hospital: A cross-sectional survey. Aust. Health Rev. 2021, 45, 771–777. [Google Scholar] [CrossRef]
- Bayuo, J.; Anago, E.K.; Agyei, F.B.; Salifu, Y.; Baffour, P.K.; Poku, C.A. Resuscitate and Push: End-of-life care experiences of healthcare staff in the emergency department–A hermeneutic phenomenological study. J. Palliat. Care 2022, 37, 494–502. [Google Scholar] [CrossRef]
- Mitchell, I.; Lacey, J.; Anstey, M.; Corbett, C.; Douglas, C.; Drummond, C.; Hensley, M.; Mills, A.; Scott, C.; Slee, J.A.; et al. Understanding end-of-life care in Australian hospitals. Aust. Health Rev. 2021, 45, 540–547. [Google Scholar] [CrossRef]
- Rumbold, B.; Aoun, S.M. Palliative and end-of-life care service models: To what extent are consumer perspectives considered? Healthcare 2021, 9, 1286. [Google Scholar] [CrossRef]
- Gunasekaran, B.; Scott, C.; Ducharlet, K.; Marco, D.; Mitchell, I.; Weil, J. Recognising and managing dying patients in the acute hospital setting: Can we do better? Intern. Med. J. 2019, 49, 119–122. [Google Scholar] [CrossRef]
- Gott, M.; Robinson, J.; Moeke-Maxwell, T.; Black, S.; Williams, L.; Wharemate, R.; Wiles, J. ‘It was peaceful, it was beautiful’: A qualitative study of family understandings of good end-of-life care in hospital for people dying in advanced age. Palliat. Med. 2019, 33, 793–801. [Google Scholar] [CrossRef]
- Lewis, E.T.; Hammill, K.A.; Ticehurst, M.; Turner, R.M.; Greenaway, S.; Hillman, K.; Carlini, J.; Cardona, M. How do patients with life-limiting illness and caregivers want end-of-life prognostic information delivered? A pilot study. Healthcare 2021, 9, 784. [Google Scholar] [CrossRef] [PubMed]
- Taylor, P.; Dowding, D.; Johnson, M. Clinical decision making in the recognition of dying: A qualitative interview study. BMC Palliat. Care 2017, 16, 11. [Google Scholar] [CrossRef]
- Paice, J.A. The interdisciplinary team. In Palliative Care: Core Skills and Clinical Competencies, 2nd ed.; Emanuel, L.L., Librach, S.L., Eds.; W.B. Saunders: Philadelphia, PA, USA, 2011; pp. 540–551. [Google Scholar]
- Palliative Care Australia. What is Palliative Care. 2015. Available online: https://palliativecare.org.au/resource/what-is-palliative-care/ (accessed on 20 September 2024).
- Australian Institute of Health and Welfare. Palliative Care Services in Australia. 2023. Available online: https://www.aihw.gov.au/reports/palliative-care-services/palliative-care-services-in-australia/contents/overview (accessed on 20 September 2024).
- Palliative Care Australia. National Palliative Care Standards. 2018. Available online: https://palliativecare.org.au/national-palliative-care-standards/ (accessed on 2 June 2025).
- Australian Commission on Safety and Quality in Health Care. Delivering and Supporting Comprehensive End-of-Life Care: A User Guide; ACSQHC: Sydney, Australia, 2021. Available online: https://www.safetyandquality.gov.au/sites/default/files/2021-05/website_eolc_user_guide.pdf (accessed on 27 September 2024).
- Valli, G.; Galati, E.; De Marco, F.; Bucci, C.; Fratini, P.; Cennamo, E.; Ancona, C.; Volpe, N.; Ruggieri, M.P. In-hospital mortality in the emergency department: Clinical and etiological differences between early and late deaths among patients awaiting admission. Clin. Exp. Emerg. Med. 2021, 8, 325–332. [Google Scholar] [CrossRef]
- Crossman, J.; Bordia, S. Handbook of Qualitative Research Methodologies in Workplace Contexts; Edward Elgar Publishing: Cheltenham, UK, 2021. [Google Scholar]
- Joubert, L.; Webber, M. The Routledge Handbook of Social Work Practice Research; Taylor Francis Group: London, UK, 2020. [Google Scholar]
Table 1.
Survey questions.
| Survey Question | Scale | How It Relates to the Research Aims and Focus |
|---|---|---|
| Male/Female/Non Binary/Prefer not to Say | Demographic related. |
| Multiple choice and Free Text | Demographic related. |
| Multiple choice | Establishing baseline knowledge of the experience of staff working in end-of-life care at The Sutherland Hospital in an acute hospital setting context. |
| Multiple choice | Establishing what clinical area of end-of-life care each participant has experienced. |
| Always/Usually/Sometimes/Rarely/ Never | To understand the current gaps within the services offered on each ward for each discipline. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | Investigate the barriers associated with the experience of end-of-life care. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To measure the experience of participants working with other disciplines and whether there are gaps within the services offered in an end-of-life care context. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand the disciplinary experience of staff within end-of-life care impacted by other disciplines throughout the acute setting of The Sutherland Hospital. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand the disciplinary experience of staff within end-of-life care impacted by other disciplines throughout the acute setting of The Sutherland Hospital. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand the disciplinary experience of staff within end-of-life care impacted by other disciplines throughout the acute setting of The Sutherland Hospital. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree/Not applicable | To understand the disciplinary experience of staff within end-of-life care impacted by other disciplines throughout the acute setting of The Sutherland Hospital. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand the current gaps and barriers associated with the decision making of different disciplines which has the potential to impact staff and the end-of-life care offered. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand the current gaps and barriers associated with the decision making of different disciplines which has the potential to impact staff and the end-of-life care offered. |
| Always/Usually/Sometimes/Rarely/ Never | To investigate the barriers associated with the experience of end-of-life care and how it is offered. |
| Yes/No/Unsure | To explore the experience of staff providing end-of-life care in an acute hospital setting and to determine how staff are impacted by other disciplines. |
| Yes/No/Unsure | To determine the role of different disciplines within the acute setting of The Sutherland Hospital and to identify whether a majority of participants experience speaking with end-of-life care patients and families. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand whether staff within the acute setting of The Sutherland Hospital feel they are personally prepared to have conversations about death and dying with patients and their families. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand if participants feel through their experience that other disciplines within The Sutherland Hospital are prepared to have conversations about death and dying with patients and their families. Identifying gaps and barriers. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand if participants feel through their experience that other disciplines within The Sutherland Hospital are prepared to have conversations about death and dying with patients and their families. Identifying gaps and barriers. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand if participants feel through their experience that other disciplines within The Sutherland Hospital are prepared to have conversations about death and dying with patients and their families. Identifying gaps and barriers. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand if participants feel through their experience that other disciplines within The Sutherland Hospital are prepared to have conversations about death and dying with patients and their families. Identifying gaps and barriers. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To understand if participants feel through their experience that other disciplines within The Sutherland Hospital are prepared to have conversations about death and dying with patients and their families. Identifying gaps and barriers. |
| Tick all that apply | To explore the educational experience of staff providing end-of-life care at The Sutherland Hospital. |
| Always/Usually/Sometimes/Rarely/ Never | To establish how the term experience is understood in an acute setting. To explore the personal experience of staff providing end-of-life care and its impact on staff wellbeing. |
| Always/Usually/Sometimes/Rarely/ Never | To establish how the term experience is understood in an acute setting. To explore the personal experience of staff providing end-of-life care and its impact on staff wellbeing. |
| Always/Usually/Sometimes/Rarely/ Never | To identify whether there are barriers associated with delivering effective end-of-life care to patients. |
| Always/Usually/Sometimes/Rarely/ Never | To determine whether there are current gaps within the services offered in end-of-life care in the acute setting of The Sutherland Hospital. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To explore the current experience of staff providing end-of-life care and offer recommendations to The Sutherland Hospital and the healthcare community. |
| Multiple choice | To understand how the disciplinary experience of staff working in an end-of-life care capacity is impacted by the decision making of other disciplines throughout the acute setting of The Sutherland Hospital. |
| Multiple choice | To understand how the disciplinary experience of staff working in an end-of-life care capacity is impacted by the decision making of other disciplines throughout the acute setting of The Sutherland Hospital. |
| Strongly agree/Agree/Neither agree nor disagree/Disagree/Strongly disagree | To explore the personal and professional experience of staff providing end-of-life care, and in doing so, investigate any barriers or gaps. |
| Free Text | To offer recommendations to the hospital and the healthcare community for improvement to the end-of-life care experience. |
Table 2.
Overview of participating disciplines.
| Discipline | Number | Percentage |
|---|---|---|
| Nursing | n = 19 | 27.5% |
| Social Workers | n = 12 | 17.4% |
| Occupational Therapy | n = 10 | 14.5% |
| Junior Doctors | n = 9 | 13% |
| Physiotherapy | n = 8 | 11.6% |
| Dietetics | n = 5 | 7.2% |
| Speech Pathology | n = 2 | 2.9% |
| Medical Consultant | n = 1 | 1.4% |
| Occupational Therapy Assistant | n = 1 | 1.4% |
| Ward Clerk | n = 1 | 1.4% |
| Ward Person | n = 1 | 1.4% |
| Unidentified | n = 1 | Not included |
Table 3.
Confidence levels since graduation.
| Years of Clinical Experience Since Graduation | ||||||
|---|---|---|---|---|---|---|
| AC | 0–1 Year | 2–5 Years | 6–10 Years | >10 Years | Total | |
| Not confident | Observed | 7 | 8 | 1 | 3 | 19 |
| Expected | 4.61 | 7.33 | 2.17 | 4.89 | 19.0 | |
| % within column | 41.2% | 29.6% | 12.5% | 16.7% | 27.1% | |
| Confident | Observed | 10 | 19 | 7 | 15 | 51 |
| Expected | 12.39 | 19.67 | 5.83 | 13.11 | 51.0 | |
| % within column | 58.8% | 70.4% | 87.5% | 83.3% | 72.9% | |
| Total | Observed | 17 | 27 | 8 | 18 | 70 |
| Expected | 17.00 | 27.00 | 8.00 | 18.00 | 70.0 | |
| % within column | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | |
Table 4.
Timely decision making in end-of-life care.
| Strongly Disagree | Disagree | Neutral | Agree | Strongly Agree | |
|---|---|---|---|---|---|
| Consultants make timely decisions regarding end-of-life care | 1.4% (n = 1) | 21.7% (n = 15) | 18.8% (n = 13) | 44.9% (n = 31) | 13% (n = 9) |
| Junior doctors make timely decisions regarding end-of-life care | 10.3% (n = 7) | 11.8% (n = 8) | 38.2% (n = 26) | 30.9% (n = 21) | 8.8% (n = 6) |
Table 5.
Post hoc skills comparisons.
| Skills | Skills | Mean Difference | SE | df | t | Ptukey |
|---|---|---|---|---|---|---|
| recognising | talking | 0.134 | 0.0518 | 60.0 | 2.60 | 0.012 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
MDPI and ACS Style
Werrett, M.; McIlveen, J.; Fox, M. Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting. Hospitals 2025, 2, 15. https://doi.org/10.3390/hospitals2030015
AMA Style
Werrett M, McIlveen J, Fox M. Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting. Hospitals. 2025; 2(3):15. https://doi.org/10.3390/hospitals2030015
Chicago/Turabian StyleWerrett, Mia, Joanna McIlveen, and Mim Fox. 2025. "Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting" Hospitals 2, no. 3: 15. https://doi.org/10.3390/hospitals2030015
APA StyleWerrett, M., McIlveen, J., & Fox, M. (2025). Multidisciplinary Staff Experiences of Providing End-of-Life Care in an Acute Hospital Setting. Hospitals, 2(3), 15. https://doi.org/10.3390/hospitals2030015
