Challenges in end-of-life and death care management in Portuguese residential care facilities: A qualitative study

Structural, organizational, and relational challenges continue to limit the quality of end-of-life care delivered in Residential Care Facilities (RCFs).

To explore the main barriers and constraints experienced by healthcare professionals in providing end-of-life care in Portuguese RCFs.

A qualitative exploratory descriptive study was conducted using an online focus group with eight healthcare professionals (physicians, nurses, and a physiotherapist) with clinical experience in RCFs and advanced training in palliative care. Data were analyzed thematically following Braun and Clarke's six-phase framework, supported by webQDA software.

Five interrelated themes were identified: (1) organizational and internal communication weaknesses; (2) structural and technical limitations; (3) lack of protocols and early planning; (4) limitations in coordination with external teams; and (5) cultural and emotional barriers related to death.

Findings indicate that improving end-of-life care in RCFs requires prioritizing actionable institutional strategies, including clear protocols, early care planning, staff education in generalist end-of-life care, and structured collaboration with external palliative care teams for complex cases. Longer-term efforts are also needed to address cultural taboos surrounding death and to support professionals' emotional well-being.