title: Developing targets for public health initiatives to improve palliative care.
abstract: BACKGROUND
  Palliative Care is an approach that improves quality of life for patients and their families facing the problems associated with incurable life-threatening illness. In many countries, due to the rapidly ageing population, increasingly more people are suffering from serious chronic disease towards the end of life, making further development in palliative care a major public health challenge. The aim of this study was to develop the first targets for public health initiatives to improve palliative care in Germany.
  
  
  METHODS
  Based on the findings from pilot studies (qualitative interviews and surveys with different stakeholders in the health care system), we conducted a modified Delphi study with two rounds of questionnaires with experts in public health and palliative care. In the first round, the experts commented on the findings from the pilot studies. The answers were evaluated descriptively and with qualitative content analysis, resulting in the formulation of 25 targets. These were presented to the experts in the second Delphi round to assess each of them separately with regard to its importance and current implementation (7-point answer scales) and in relation to the other targets (defining the five most important of the 25 targets).
  
  
  RESULTS
  Six most relevant targets for public health initiatives to improve palliative care in Germany were worked out: Supporting palliative care as a basic attitude for the care of people in the last phase of life; coordinating healthcare for people in the last phase of life; establishing cooperation among health professions and disciplines; establishing education in palliative care for all professional groups with contact to people in the last phase of life; reviewing the evidence of palliative care measures; offering support to family members who are caring for someone in the last phase of life.
  
  
  CONCLUSIONS
  To systematically develop palliative care, it makes sense to define fields of action with individual targets. For Germany, it can be recommended to give priority to the targets that were highlighted as the most relevant in this study. The next step will be to develop, implement and evaluate tangible measures to achieve these targets.
authors.affiliation: Hannover Medical School, Centre for Public Health and Healthcare, Institute for Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str,1, 30625 Hannover, Germany. schneider.nils@mh-hannover.de
authors.forename: Nils
authors.initials: N
authors.lastname: Schneider
authors.forename: Sara L
authors.initials: SL
authors.lastname: Lueckmann
authors.forename: Franziska
authors.initials: F
authors.lastname: Kuehne
authors.forename: Katharina
authors.initials: K
authors.lastname: Klindtworth
authors.forename: Mareike
authors.initials: M
authors.lastname: Behmann
mesh_terms: D003266:Continuity of Patient Care / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards; D003697:Delphi Technique; D005190:Family; D005858:Germany; D006282:Health Personnel / Q000193:education; D006801:Humans; D010166:Palliative Care; D010348:Patient Care Team / Q000592:standards; D015980:Public Health Practice / Q000592:standards*; D058996:Quality Improvement