{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T11:33:38Z","timestamp":1788262418304,"version":"build-2803163510"},"reference-count":60,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T00:00:00Z","timestamp":1771545600000},"content-version":"vor","delay-in-days":22,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>As the number and complexity of patients living with serious illness continue to rise, delivering care that is both effective and responsive to individual life contexts has become increasingly important. Despite its potential benefits, the implementation of contextualized care in the management of serious illness remains limited and poorly understood. To address this gap, this study aimed to identify barriers and facilitators influencing the delivery of contextualized care for patients with serious illness, as perceived by healthcare professionals (HCPs), and to generate recommendations for improving its implementation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Three focus groups were conducted with 20 HCPs from multiple disciplines and hospital settings in the Netherlands, all involved in the care of patients with serious illness. Discussions were guided and analysed using a directed content analysis informed by the COM-B model (Capability, Opportunity, Motivation\u2013Behaviour) combined with the Theoretical Domains Framework. Factors were mapped to intervention functions from the Behaviour Change Wheel (BCW) to provide recommendations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Nine factors influencing contextualized care were identified across COM-B components. Capability-related factors included skills and knowledge to engage with the relevant patient context and the ability to distinguish between general and clinically relevant context. Opportunity-related factors included environmental conditions, fragmented information systems, systemic incentives misaligned with contextual care, a lack of shared team norms, collaboration challenges, and the perceived emotional complexity of contextual conversations in the palliative phase. Motivation-related factors included strong intrinsic commitment to person-centred care and awareness of the consequences of overlooking context for patients, HCPs, and the overall system. Most barriers were concentrated in the\n                      <jats:italic>Opportunity<\/jats:italic>\n                      component, with environmental and team-level constraints often outweighing individual motivation and basic skills.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Delivering contextualized care for patients with serious illness is not primarily limited by individual willingness or basic capability but by environmental and systemic feasibility. Sustainable implementation requires multilevel strategies targeting team culture, interprofessional collaboration, and a supportive infrastructure. Moving from individual intent to shared norms may improve both patient outcomes and resource efficiency. Key steps include continuous education, embedding contextual care in team culture, adapting workflows and documentation, and integrating contextualization into quality measures and incentives.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12916-026-04662-w","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T08:53:00Z","timestamp":1769676780000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors impacting the delivery of contextualized care in serious illness: a focus group study with healthcare professionals"],"prefix":"10.1186","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-2522-9889","authenticated-orcid":false,"given":"Linda","family":"Modderkolk","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Schoon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hugo","family":"Touw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Engels","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anne B.","family":"Wichmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"4662_CR1","doi-asserted-by":"publisher","first-page":"985","DOI":"10.1089\/jpm.2014.0164","volume":"17","author":"AS Kelley","year":"2014","unstructured":"Kelley AS. Defining \u201cserious illness.\u201d J Palliat Med. 2014;17:985. https:\/\/doi.org\/10.1089\/jpm.2014.0164.","journal-title":"J Palliat Med"},{"key":"4662_CR2","doi-asserted-by":"publisher","first-page":"1086","DOI":"10.1177\/1049909120928353","volume":"37","author":"KP Murali","year":"2020","unstructured":"Murali KP, Merriman JD, Yu G, Vorderstrasse A, Kelley A, Brody AA. An adapted conceptual model integrating palliative care in serious illness and multiple chronic conditions. Am J Hosp Palliat Care. 2020;37:1086\u201395. https:\/\/doi.org\/10.1177\/1049909120928353.","journal-title":"Am J Hosp Palliat Care"},{"key":"4662_CR3","doi-asserted-by":"publisher","first-page":"73","DOI":"10.12927\/hcpol.2014.23811","volume":"9","author":"A Gill","year":"2014","unstructured":"Gill A, Kuluski K, Jaakkimainen L, Naganathan G, Upshur R, Wodchis WP. \u201cWhere do we go from here?\u201d Health system frustrations expressed by patients with multimorbidity, their caregivers and family physicians. Healthcare Policy | Politiques de Sant\u00e9. 2014;9:73\u201389. https:\/\/doi.org\/10.12927\/hcpol.2014.23811.","journal-title":"Healthcare Policy | Politiques de Sant\u00e9"},{"key":"4662_CR4","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1186\/s12875-024-02633-9","volume":"25","author":"ME Perron","year":"2024","unstructured":"Perron ME, Hudon C, Roux-Levy PH, Poitras ME. Shared decision-making with patients with complex care needs: a scoping review. BMC Prim Care. 2024;25:390. https:\/\/doi.org\/10.1186\/s12875-024-02633-9.","journal-title":"BMC Prim Care"},{"key":"4662_CR5","unstructured":"Weiner SJ, Schwartz A. Listening for what matters: avoiding contextual errors in health care. Oxford University Press; 2023. Available: https:\/\/play.google.com\/store\/books\/details?id=yBLIEAAAQBAJ"},{"key":"4662_CR6","unstructured":"Vonk et al. RA. [Exploring the future of healthcare expenditures 2015\u20132060. Quantitative Preliminary Study Commissioned by the Scientific Council for Government Policy. Part 1: Future Projections.] 2020."},{"key":"4662_CR7","doi-asserted-by":"publisher","unstructured":"van Dijk CE, Langereis T, Dik J-WH, Hoekstra T, van den Berg B. The health and long-term care costs in the last year of life in the Netherlands. Eur J Health Econ. 2025:1\u201314. https:\/\/doi.org\/10.1007\/s10198-025-01763-w","DOI":"10.1007\/s10198-025-01763-w"},{"key":"4662_CR8","doi-asserted-by":"publisher","first-page":"1720","DOI":"10.1016\/j.socscimed.2006.04.018","volume":"63","author":"JJ Polder","year":"2006","unstructured":"Polder JJ, Barendregt JJ, van Oers H. Health care costs in the last year of life--the Dutch experience. Soc Sci Med. 2006;63:1720\u201331. https:\/\/doi.org\/10.1016\/j.socscimed.2006.04.018.","journal-title":"Soc Sci Med"},{"key":"4662_CR9","doi-asserted-by":"publisher","first-page":"1665","DOI":"10.1001\/jama.300.14.1665","volume":"300","author":"AA Wright","year":"2008","unstructured":"Wright AA, Zhang B, Ray A, Mack JW, Trice E, Balboni T, et al. Associations between end-of-life discussions, patient mental health, medical care near death, and caregiver bereavement adjustment. JAMA. 2008;300:1665\u201373. https:\/\/doi.org\/10.1001\/jama.300.14.1665.","journal-title":"JAMA"},{"key":"4662_CR10","doi-asserted-by":"publisher","first-page":"110","DOI":"10.1016\/s0749-2081(98)80016-8","volume":"14","author":"JV Pasacreta","year":"1998","unstructured":"Pasacreta JV, Pickett M. Psychosocial aspects of palliative care. Semin Oncol Nurs. 1998;14:110\u201320. https:\/\/doi.org\/10.1016\/s0749-2081(98)80016-8.","journal-title":"Semin Oncol Nurs"},{"key":"4662_CR11","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1007\/s00520-023-08198-0","volume":"31","author":"L Ham","year":"2023","unstructured":"Ham L, Slotman E, Burghout C, Raijmakers NJ, van de Poll-Franse LV, van Zuylen L, et al. Potentially inappropriate end-of-life care and its association with relatives\u2019 well-being: a systematic review. Support Care Cancer. 2023;31:731. https:\/\/doi.org\/10.1007\/s00520-023-08198-0.","journal-title":"Support Care Cancer"},{"key":"4662_CR12","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1186\/s12904-022-01096-y","volume":"21","author":"M Hasdenteufel","year":"2022","unstructured":"Hasdenteufel M, Quintard B. Psychosocial factors affecting the bereavement experience of relatives of palliative-stage cancer patients: a systematic review. BMC Palliat Care. 2022;21:212. https:\/\/doi.org\/10.1186\/s12904-022-01096-y.","journal-title":"BMC Palliat Care"},{"key":"4662_CR13","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1186\/s12904-023-01261-x","volume":"22","author":"Y Yang","year":"2023","unstructured":"Yang Y, Zhao X, Cui M, Wang Y. Dimensions of spiritual well-being in relation to physical and psychological symptoms: a cross-sectional study of advanced cancer patients admitted to a palliative care unit. BMC Palliat Care. 2023;22:137. https:\/\/doi.org\/10.1186\/s12904-023-01261-x.","journal-title":"BMC Palliat Care"},{"key":"4662_CR14","unstructured":"Rego F, Pereira C, Rego G, Nunes R. The psychological and spiritual dimensions of palliative care: a descriptive systematic review. Neuropsychiatry. 2018;8:484\u2013494. Available: https:\/\/www.academia.edu\/download\/68264238\/17e633eafb301f797159844203617882388b.pdf"},{"key":"4662_CR15","doi-asserted-by":"publisher","first-page":"1361","DOI":"10.1007\/s11606-012-2077-6","volume":"27","author":"G Elwyn","year":"2012","unstructured":"Elwyn G, Frosch D, Thomson R, Joseph-Williams N, Lloyd A, Kinnersley P, et al. Shared decision making: a model for clinical practice. J Gen Intern Med. 2012;27:1361\u20137. https:\/\/doi.org\/10.1007\/s11606-012-2077-6.","journal-title":"J Gen Intern Med"},{"key":"4662_CR16","doi-asserted-by":"publisher","DOI":"10.1186\/s12910-023-00944-7","volume":"24","author":"A Rosca","year":"2023","unstructured":"Rosca A, Karzig-Roduner I, Kasper J, Rogger N, Drewniak D, Krones T. Shared decision making and advance care planning: a systematic literature review and novel decision-making model. BMC Med Ethics. 2023;24:64. https:\/\/doi.org\/10.1186\/s12910-023-00944-7.","journal-title":"BMC Med Ethics"},{"key":"4662_CR17","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(17)30582-X","volume":"18","author":"JAC Rietjens","year":"2017","unstructured":"Rietjens JAC, Sudore RL, Connolly M, van Delden JJ, Drickamer MA, Droger M, et al. Definition and recommendations for advance care planning: an international consensus supported by the European Association for Palliative Care. Lancet Oncol. 2017;18:e543. https:\/\/doi.org\/10.1016\/S1470-2045(17)30582-X.","journal-title":"Lancet Oncol"},{"key":"4662_CR18","doi-asserted-by":"publisher","first-page":"821","DOI":"10.1016\/j.jpainsymman.2016.12.331","volume":"53","author":"RL Sudore","year":"2017","unstructured":"Sudore RL, Lum HD, You JJ, Hanson LC, Meier DE, Pantilat SZ, et al. Defining advance care planning for adults: a consensus definition from a multidisciplinary Delphi panel. J Pain Symptom Manage. 2017;53:821-832.e1. https:\/\/doi.org\/10.1016\/j.jpainsymman.2016.12.331.","journal-title":"J Pain Symptom Manage"},{"key":"4662_CR19","doi-asserted-by":"publisher","first-page":"2860","DOI":"10.1016\/j.pec.2022.05.009","volume":"105","author":"EA Rake","year":"2022","unstructured":"Rake EA, Box ICH, Dreesens D, Meinders MJ, Kremer JAM, Aarts JWM, et al. Bringing personal perspective elicitation to the heart of shared decision-making: a scoping review. Patient Educ Couns. 2022;105:2860\u201370. https:\/\/doi.org\/10.1016\/j.pec.2022.05.009.","journal-title":"Patient Educ Couns"},{"key":"4662_CR20","doi-asserted-by":"publisher","first-page":"657","DOI":"10.1097\/ACM.0000000000001017","volume":"91","author":"SJ Weiner","year":"2016","unstructured":"Weiner SJ, Schwartz A. Contextual errors in medical decision making: overlooked and understudied. Acad Med. 2016;91:657\u201362. https:\/\/doi.org\/10.1097\/ACM.0000000000001017.","journal-title":"Acad Med"},{"key":"4662_CR21","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04730-2","volume":"23","author":"HL Moore","year":"2023","unstructured":"Moore HL, Watson R, Farnworth A, Giles K, Tomson D, Thomson RG. Inclusion of person-centred care in UK postgraduate medical education curricula: interviews and documentary analysis. BMC Med Educ. 2023;23:757. https:\/\/doi.org\/10.1186\/s12909-023-04730-2.","journal-title":"BMC Med Educ"},{"key":"4662_CR22","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-022-03657-4","volume":"22","author":"I Bj\u00f6rkman","year":"2022","unstructured":"Bj\u00f6rkman I, Feldthusen C, Forsgren E, Jonnerg\u00e5rd A, Lindstr\u00f6m Kjellberg I, Wallengren Gustafsson C, et al. Person-centred care on the move - an interview study with programme directors in Swedish higher education. BMC Med Educ. 2022;22:589. https:\/\/doi.org\/10.1186\/s12909-022-03657-4.","journal-title":"BMC Med Educ"},{"key":"4662_CR23","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-024-05885-2","volume":"24","author":"A Jonnerg\u00e5rd","year":"2024","unstructured":"Jonnerg\u00e5rd A, Bj\u00f6rkman I, Forsgren E, Feldthusen C, Lundberg M, Wallengren C. Person-centred care in the context of higher education - a discourse analysis based on interviews with programme directors. BMC Med Educ. 2024;24:873. https:\/\/doi.org\/10.1186\/s12909-024-05885-2.","journal-title":"BMC Med Educ"},{"key":"4662_CR24","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0282802","volume":"18","author":"A Ahmed","year":"2023","unstructured":"Ahmed A, van den Muijsenbergh METC, Vrijhoef HJM. Person-centred care in the Dutch primary care setting: refinement of middle-range theory by patients and professionals. PLoS ONE. 2023;18:e0282802. https:\/\/doi.org\/10.1371\/journal.pone.0282802.","journal-title":"PLoS ONE"},{"key":"4662_CR25","doi-asserted-by":"publisher","first-page":"843","DOI":"10.1017\/S1478951522000980","volume":"21","author":"A-F Dijxhoorn","year":"2023","unstructured":"Dijxhoorn A-F, Raijmakers N, van der Linden Y, Leget C, Brom L. Clinicians\u2019 perceptions of the emotional impact of providing palliative care: a qualitative interview study. Palliat Support Care. 2023;21:843\u20139. https:\/\/doi.org\/10.1017\/S1478951522000980.","journal-title":"Palliat Support Care"},{"key":"4662_CR26","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1016\/j.gerinurse.2024.08.042","volume":"60","author":"FBAL Peerboom","year":"2024","unstructured":"Peerboom FBAL, Friesen-Storms JHHM, van der Steen JT, Janssen DJA, Meijers JMM. Fundamentals of end-of-life communication as part of advance care planning for older people: an interview study with nursing staff. Geriatr Nurs. 2024;60:59\u201369. https:\/\/doi.org\/10.1016\/j.gerinurse.2024.08.042.","journal-title":"Geriatr Nurs"},{"key":"4662_CR27","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.3399\/bjgp11X549018","volume":"61","author":"S Barclay","year":"2011","unstructured":"Barclay S, Momen N, Case-Upton S, Kuhn I, Smith E. End-of-life care conversations with heart failure patients: a systematic literature review and narrative synthesis. Br J Gen Pract. 2011;61:e49-62. https:\/\/doi.org\/10.3399\/bjgp11X549018.","journal-title":"Br J Gen Pract"},{"key":"4662_CR28","doi-asserted-by":"publisher","first-page":"e95","DOI":"10.1183\/20734735.013717","volume":"13","author":"FWJM Smeenk","year":"2017","unstructured":"Smeenk FWJM, Schrijver LA, van Bavel HCJ, van de Laar EFJ. Talking about end-of-life care in a timely manner. Breathe. 2017;13:e95\u2013102. https:\/\/doi.org\/10.1183\/20734735.013717.","journal-title":"Breathe"},{"key":"4662_CR29","doi-asserted-by":"publisher","first-page":"594","DOI":"10.1016\/j.pec.2021.06.016","volume":"105","author":"SJ Weiner","year":"2022","unstructured":"Weiner SJ. Contextualizing care: an essential and measurable clinical competency. Patient Educ Couns. 2022;105:594\u20138. https:\/\/doi.org\/10.1016\/j.pec.2021.06.016.","journal-title":"Patient Educ Couns"},{"key":"4662_CR30","doi-asserted-by":"publisher","DOI":"10.1186\/s13012-017-0605-9","volume":"12","author":"L Atkins","year":"2017","unstructured":"Atkins L, Francis J, Islam R, O\u2019Connor D, Patey A, Ivers N, et al. A guide to using the theoretical domains framework of behaviour change to investigate implementation problems. Implement Sci. 2017;12:77. https:\/\/doi.org\/10.1186\/s13012-017-0605-9.","journal-title":"Implement Sci"},{"key":"4662_CR31","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-6-42","author":"S Michie","year":"2011","unstructured":"Michie S, van Stralen MM, West R. The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implement Sci. 2011. https:\/\/doi.org\/10.1186\/1748-5908-6-42.","journal-title":"Implement Sci"},{"key":"4662_CR32","doi-asserted-by":"publisher","DOI":"10.1186\/1748-5908-7-37","volume":"7","author":"J Cane","year":"2012","unstructured":"Cane J, O\u2019Connor D, Michie S. Validation of the theoretical domains framework for use in behaviour change and implementation research. Implement Sci. 2012;7:37. https:\/\/doi.org\/10.1186\/1748-5908-7-37.","journal-title":"Implement Sci"},{"key":"4662_CR33","doi-asserted-by":"publisher","first-page":"617","DOI":"10.1016\/j.gie.2015.08.075","volume":"83","author":"L Atkins","year":"2016","unstructured":"Atkins L, Hunkeler EM, Jensen CD, Michie S, Lee JK, Doubeni CA, et al. Factors influencing variation in physician adenoma detection rates: a theory-based approach for performance improvement. Gastrointest Endosc. 2016;83:617-26.e2. https:\/\/doi.org\/10.1016\/j.gie.2015.08.075.","journal-title":"Gastrointest Endosc"},{"key":"4662_CR34","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1136\/qshc.2004.011155","volume":"14","author":"S Michie","year":"2005","unstructured":"Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A, et al. Making psychological theory useful for implementing evidence based practice: a consensus approach. Qual Saf Health Care. 2005;14:26\u201333. https:\/\/doi.org\/10.1136\/qshc.2004.011155.","journal-title":"Qual Saf Health Care"},{"key":"4662_CR35","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1177\/1525822X05279903","volume":"18","author":"G Guest","year":"2006","unstructured":"Guest G, Bunce A, Johnson L. How many interviews are enough? Field Methods. 2006;18:59\u201382. https:\/\/doi.org\/10.1177\/1525822X05279903.","journal-title":"Field Methods"},{"key":"4662_CR36","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnsa.2024.100174","volume":"6","author":"S Rahimi","year":"2024","unstructured":"Rahimi S, Khatooni M. Saturation in qualitative research: an evolutionary concept analysis. Int J Nurs Stud Adv. 2024;6:100174. https:\/\/doi.org\/10.1016\/j.ijnsa.2024.100174.","journal-title":"Int J Nurs Stud Adv"},{"key":"4662_CR37","doi-asserted-by":"publisher","first-page":"655","DOI":"10.1079\/pns2004399","volume":"63","author":"F Rabiee","year":"2004","unstructured":"Rabiee F. Focus-group interview and data analysis. Proc Nutr Soc. 2004;63:655\u201360. https:\/\/doi.org\/10.1079\/pns2004399.","journal-title":"Proc Nutr Soc"},{"key":"4662_CR38","doi-asserted-by":"publisher","first-page":"1483","DOI":"10.1177\/1049732318821692","volume":"29","author":"MM Hennink","year":"2019","unstructured":"Hennink MM, Kaiser BN, Weber MB. What influences saturation? Estimating sample sizes in focus group research. Qual Health Res. 2019;29:1483\u201396. https:\/\/doi.org\/10.1177\/1049732318821692.","journal-title":"Qual Health Res"},{"key":"4662_CR39","doi-asserted-by":"publisher","first-page":"591","DOI":"10.1177\/1049732316665344","volume":"27","author":"MM Hennink","year":"2017","unstructured":"Hennink MM, Kaiser BN, Marconi VC. Code saturation versus meaning saturation: how many interviews are enough? Qual Health Res. 2017;27:591\u2013608. https:\/\/doi.org\/10.1177\/1049732316665344.","journal-title":"Qual Health Res"},{"key":"4662_CR40","doi-asserted-by":"publisher","first-page":"1277","DOI":"10.1177\/1049732305276687","volume":"15","author":"H-F Hsieh","year":"2005","unstructured":"Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res. 2005;15:1277\u201388. https:\/\/doi.org\/10.1177\/1049732305276687.","journal-title":"Qual Health Res"},{"key":"4662_CR41","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19:349\u201357. https:\/\/doi.org\/10.1093\/intqhc\/mzm042.","journal-title":"Int J Qual Health Care"},{"key":"4662_CR42","doi-asserted-by":"publisher","first-page":"5383","DOI":"10.1002\/cncr.26221","volume":"117","author":"T Balboni","year":"2011","unstructured":"Balboni T, Balboni M, Paulk ME, Phelps A, Wright A, Peteet J, et al. Support of cancer patients\u2019 spiritual needs and associations with medical care costs at the end of life. Cancer. 2011;117:5383\u201391. https:\/\/doi.org\/10.1002\/cncr.26221.","journal-title":"Cancer"},{"key":"4662_CR43","doi-asserted-by":"publisher","first-page":"e439","DOI":"10.1016\/j.jpainsymman.2023.01.022","volume":"65","author":"AJ Kirkpatrick","year":"2023","unstructured":"Kirkpatrick AJ, Donesky D, Kitko LA. A systematic review of interprofessional palliative care education programs. J Pain Symptom Manage. 2023;65:e439\u201366. https:\/\/doi.org\/10.1016\/j.jpainsymman.2023.01.022.","journal-title":"J Pain Symptom Manage"},{"key":"4662_CR44","doi-asserted-by":"publisher","first-page":"356","DOI":"10.3322\/caac.21490","volume":"68","author":"D Hui","year":"2018","unstructured":"Hui D, Hannon BL, Zimmermann C, Bruera E. Improving patient and caregiver outcomes in oncology: team-based, timely, and targeted palliative care: timely palliative care for cancer patients. CA Cancer J Clin. 2018;68:356\u201376. https:\/\/doi.org\/10.3322\/caac.21490.","journal-title":"CA Cancer J Clin"},{"key":"4662_CR45","doi-asserted-by":"publisher","first-page":"219","DOI":"10.1016\/j.berh.2009.12.013","volume":"24","author":"CJ Main","year":"2010","unstructured":"Main CJ, Buchbinder R, Porcheret M, Foster N. Addressing patient beliefs and expectations in the consultation. Best Pract Res Clin Rheumatol. 2010;24:219\u201325. https:\/\/doi.org\/10.1016\/j.berh.2009.12.013.","journal-title":"Best Pract Res Clin Rheumatol"},{"key":"4662_CR46","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1136\/bmj.325.7366.697","volume":"325","author":"P Maguire","year":"2002","unstructured":"Maguire P, Pitceathly C. Key communication skills and how to acquire them. BMJ. 2002;325:697\u2013700. https:\/\/doi.org\/10.1136\/bmj.325.7366.697.","journal-title":"BMJ"},{"key":"4662_CR47","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1111\/j.1365-2923.1996.tb00724.x","volume":"30","author":"SM Kurtz","year":"1996","unstructured":"Kurtz SM, Silverman JD. The calgary-cambridge referenced observation guides: an aid to defining the curriculum and organizing the teaching in communication training programmes. Med Educ. 1996;30:83\u20139. https:\/\/doi.org\/10.1111\/j.1365-2923.1996.tb00724.x.","journal-title":"Med Educ"},{"key":"4662_CR48","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-024-05596-8","volume":"24","author":"SP Dewi","year":"2024","unstructured":"Dewi SP, Wilson A, Duvivier R, Kelly B, Gilligan C. Do the teaching, practice and assessment of clinical communication skills align? BMC Med Educ. 2024;24:609. https:\/\/doi.org\/10.1186\/s12909-024-05596-8.","journal-title":"BMC Med Educ"},{"key":"4662_CR49","doi-asserted-by":"publisher","first-page":"246","DOI":"10.3109\/13561820.2013.821601","volume":"28","author":"P Kuipers","year":"2014","unstructured":"Kuipers P, Ehrlich C, Brownie S. Responding to health care complexity: suggestions for integrated and interprofessional workplace learning. J Interprof Care. 2014;28:246\u20138. https:\/\/doi.org\/10.3109\/13561820.2013.821601.","journal-title":"J Interprof Care"},{"key":"4662_CR50","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1016\/j.edurev.2007.12.001","volume":"3","author":"P Tynj\u00e4l\u00e4","year":"2008","unstructured":"Tynj\u00e4l\u00e4 P. Perspectives into learning at the workplace. Educ Res Rev. 2008;3:130\u201354. https:\/\/doi.org\/10.1016\/j.edurev.2007.12.001.","journal-title":"Educ Res Rev"},{"key":"4662_CR51","doi-asserted-by":"publisher","first-page":"949","DOI":"10.1097\/SLA.0000000000000721","volume":"260","author":"Z Cooper","year":"2014","unstructured":"Cooper Z, Courtwright A, Karlage A, Gawande A, Block S. Pitfalls in communication that lead to nonbeneficial emergency surgery in elderly patients with serious illness: description of the problem and elements of a solution. Ann Surg. 2014;260:949. https:\/\/doi.org\/10.1097\/SLA.0000000000000721.","journal-title":"Ann Surg"},{"key":"4662_CR52","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1016\/j.jpainsymman.2023.07.001","volume":"66","author":"GT Wasp","year":"2023","unstructured":"Wasp GT, Kaur-Gill S, Anderson EC, Vergo MT, Chelen J, Tosteson T, et al. Evaluating physician emotion regulation in serious illness conversations using multimodal assessment. J Pain Symptom Manage. 2023;66:351-360.e1. https:\/\/doi.org\/10.1016\/j.jpainsymman.2023.07.001.","journal-title":"J Pain Symptom Manage"},{"key":"4662_CR53","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-023-01141-4","volume":"22","author":"A Suslow","year":"2023","unstructured":"Suslow A, Giehl C, Hergesell J, Vollmar HC, Otte I. Impact of information and communication software on multiprofessional team collaboration in outpatient palliative care - a qualitative study on providers\u2019 perspectives. BMC Palliat Care. 2023;22:19. https:\/\/doi.org\/10.1186\/s12904-023-01141-4.","journal-title":"BMC Palliat Care"},{"key":"4662_CR54","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-024-01372-z","volume":"23","author":"S Stanley","year":"2024","unstructured":"Stanley S, Finucane A, Thompson A, Nwosu AC. How can technology be used to support communication in palliative care beyond the covid-19 pandemic: a mixed-methods national survey of palliative care healthcare professionals. BMC Palliat Care. 2024;23:40. https:\/\/doi.org\/10.1186\/s12904-024-01372-z.","journal-title":"BMC Palliat Care"},{"key":"4662_CR55","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.38231","volume":"5","author":"SJ Weiner","year":"2022","unstructured":"Weiner SJ, Schwartz A, Weaver F, Galanter W, Olender S, Kochendorfer K, et al. Effect of electronic health record clinical decision support on contextualization of care: a randomized clinical trial. JAMA Netw Open. 2022;5:e2238231. https:\/\/doi.org\/10.1001\/jamanetworkopen.2022.38231.","journal-title":"JAMA Netw Open"},{"key":"4662_CR56","doi-asserted-by":"publisher","unstructured":"W\u00f6hl M, Gimpel H, Meindl O, Ostgathe C, Peuten S, Schneider W, et al. Boosting multi-professional collaboration in palliative care through digital technologies: an action design research study. Bus Inf Syst Eng. 2024:1\u201323. https:\/\/doi.org\/10.1007\/s12599-024-00897-0","DOI":"10.1007\/s12599-024-00897-0"},{"key":"4662_CR57","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01121-0","volume":"21","author":"P Pornrattanakavee","year":"2022","unstructured":"Pornrattanakavee P, Srichan T, Seetalarom K, Saichaemchan S, Oer-Areemitr N, Prasongsook N. Impact of interprofessional collaborative practice in palliative care on outcomes for advanced cancer inpatients in a resource-limited setting. BMC Palliat Care. 2022;21:229. https:\/\/doi.org\/10.1186\/s12904-022-01121-0.","journal-title":"BMC Palliat Care"},{"key":"4662_CR58","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1097\/NJH.0000000000000428","volume":"20","author":"V Parola","year":"2018","unstructured":"Parola V, Coelho A, Sandgren A, Fernandes O, Ap\u00f3stolo J. Caring in palliative care: a phenomenological study of nurses\u2019 lived experiences. J Hosp Palliat Nurs. 2018;20:180\u20136. https:\/\/doi.org\/10.1097\/NJH.0000000000000428.","journal-title":"J Hosp Palliat Nurs"},{"key":"4662_CR59","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1080\/14461242.2024.2432881","volume":"34","author":"E Borgstrom","year":"2025","unstructured":"Borgstrom E, Cohn S, Driessen A. Multidisciplinary team meetings: dynamic routines that (re)make palliative care. Health Sociol Rev. 2025;34:77\u201391. https:\/\/doi.org\/10.1080\/14461242.2024.2432881.","journal-title":"Health Sociol Rev"},{"key":"4662_CR60","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1080\/13561820.2023.2238","volume":"38","author":"A O\u2019Donnell","year":"2024","unstructured":"O\u2019Donnell A, Gonyea J, Wensley T, Nizza M. High-quality patient-centered palliative care: interprofessional team members\u2019 perceptions of social workers\u2019 roles and contribution. J Interprof Care. 2024;38:1\u20139. https:\/\/doi.org\/10.1080\/13561820.2023.2238.","journal-title":"J Interprof Care"}],"container-title":["BMC Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12916-026-04662-w","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-026-04662-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12916-026-04662-w.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,20]],"date-time":"2026-02-20T14:31:00Z","timestamp":1771597860000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12916-026-04662-w"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":60,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4662"],"URL":"https:\/\/doi.org\/10.1186\/s12916-026-04662-w","relation":{},"ISSN":["1741-7015"],"issn-type":[{"value":"1741-7015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"assertion":[{"value":"4 November 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"As participants were not subjected to any intervention or required to modify their behaviour, the Medical Review Ethics Committee region Oost-Nederland concluded that the study did not fall within the scope of the Medical Research Involving Human Subjects Act and granted an exemption from further ethical review (case number 2023\u201316760). The study was therefore approved. Written informed consent was obtained from all participants prior to participation in the focus groups. Anonymity of both participants and patients referred to in the discussed clinical cases was safeguarded by removing all personally identifiable information from the transcripts.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"117"}}