[Initiation and implementation of pediatric palliative care in pediatric oncology: A qualitative interview study]

Initiation and implementation of pediatric palliative care in pediatric oncology: A qualitative interview study Abstract: Background: Pediatric palliative care in pediatric oncology is typically introduced only at the end of life, despite proven benefits for quality of life. Its implementation in German-speaking routine care has been little studied. Aim: The study aimed to capture the understanding and implementation of pediatric palliative care in pediatric oncology from the perspective of different professional groups and to identify barriers to and facilitators of early integration. Methods: In a qualitative descriptive study, twelve semi-structured single interviews were conducted from February to May 2024 with nurses, physicians, one psychosocial staff member and one pedagogical staff member of a German tertiary care hospital. Data were analyzed using qualitative content analysis according to Gläser and Laudel (2010), reporting follows the SRQR. Results: Key barriers are the association of "palliative" with dying, divergent definitions of when to start care, lack of pediatric-specific standards, and communication deficits. Nurses tend to identify palliative care needs earlier but are underrepresented in tumor boards. Facilitators include transparent communication, interprofessional training, spaces for ethical reflection, and early involvement of specialized outpatient palliative care. Conclusions: Early implementation requires standards aligned with the German S3-guideline, structural inclusion of nursing in decision-making forums, and a reconceptualization of "palliative" in communication with families and professionals.