Practices and perspectives on dying at home in Norwegian home care services - a secondary analysis of qualitative...

There is increasing recognition that individuals of all ages with life-limiting conditions benefit from palliative care. Despite a preference for dying at home, most patients still spend their final days in hospital. The WHO encourages member states to integrate palliative care across all levels of their health system.

This study aims to explore how home care services in a Norwegian municipality implement practices that enable patients to die at home, and how healthcare professionals experience these practices.

A secondary analysis was conducted using qualitative data originally collected in May 2024 for the evaluation of a structured care model for days at home and home death. The dataset comprised four focus groups, one with members of the project team who had developed the model, one with home care unit managers, and two with healthcare workers involved in applying the structured care model in practice. The secondary analysis was conducted between May and August 2025, using Braun and Clarke's thematic analysis.

The analyses resulted in the following three themes, which describe how home care services implement practices enabling patients to die at home, as well as their experiences of this practice: T1) Advancing palliative care through focused projects: enhancing competence and addressing challenges; T2) Spending the final days at home: identifying patients with palliative care needs and providing compassionate and effective care, and, T3) Sharing responsibility versus reducing the workload. Fostering knowledge and support in home-based palliative care. Overall, the findings showed that a recently implemented care model improved focus, procedures and collaboration, but also revealed organizational weaknesses. Palliative home care was seen as a nuanced, nonlinear process shaped by patient and family wishes, and end-of-life meetings with patients and families were described as complex, requiring both skilled care and emotional support. Yet some nurses felt insecure and called for more colleagues with whom they could share their experiences, knowledge, and responsibilities.

Supported by a newly implemented structured care model, the home care services worked systematically and purposefully to improve the quality of care for patients with palliative needs. However, the data revealed weaknesses in the system, such as a lack of clear reporting guidelines and unclear roles among collaborating healthcare services. Healthcare workers were engaged and described their work as complex and unpredictable, thus underlining the need for confidence, competence, and support from colleagues. Overall, the study demonstrates that palliative home care is enhanced by clearly articulated goals and a comprehensive understanding of the requirements needed to deliver high-quality care.