What 'capitals' are needed to enable assessment of palliative care needs in home care? A qualitative interview study with home care nurses

Home care nurses play a central role in providing palliative care to patients with life-limiting illnesses. Although holistic needs assessment is recommended, systematic assessment is not standard in primary care, and nurses often struggle to address complex psychosocial and existential concerns. PRO-Pall is a structured instrument developed to support holistic palliative care across healthcare sectors. This study explores home care nurses' experiences with PRO-Pall, focusing on its perceived benefits and implementation challenges.

Qualitative interviews were conducted with home care nurses from municipalities actively testing PRO-Pall. Data were analysed using thematic analysis. Drawing on Bourdieu's theory of practice, the analysis interprets nurses' engagement with the instrument through the concepts of habitus, field, and capital.

Two overarching themes emerged: (1) Enhancing holistic care with patients and within families, and (2) Systemic barriers to holistic care within homecare institutions and across interdisciplinary and cross-sectoral collaboration. Nurses found PRO-Pall useful for initiating sensitive conversations and adapted the tool flexibly to support individual needs. Its focus on holistic care aligned with nurses' professional habitus. However, systemic barriers, including limited time, inadequate digital infrastructure, and fragmented coordination, restricted consistent use.

Home care nurses regard PRO-Pall as a meaningful support for holistic palliative care. Effective integration depends on alignment between individual dispositions, organisational conditions, and access to social, cultural, symbolic, and economic capital. Strengthening training, resources, and collaborative structures is essential for the sustainable use of systematic needs assessments in municipal palliative care.