# Promising Concept, Challenging Implementation of a Minimally Invasive Intervention (MINI) to Identify Patients in Their Last Year of Life—A Multi-Methods Feasibility Study at a German University Hospital

## TL;DR

This study explores a new approach to identify patients needing palliative care in hospitals, finding it promising but facing implementation challenges.

## Contribution

The study introduces and evaluates a multi-method intervention (MINI) for early palliative care identification in acute hospitals.

## Key findings

- MINI was generally accepted and led to improved identification of psychosocial problems and palliative care referrals.
- Physicians felt more confident in end-of-life conversations, but other staff had mixed responses.
- Barriers like time constraints and lack of institutional support hindered MINI's sustainability.

## Abstract

Background/Objectives: Identifying patients with palliative care needs can be challenging in clinical practice. This study reports on the tailoring and evaluation of a minimally invasive intervention (MINI) to support early planning of palliative care in acute hospitals. The MINI includes the Surprise Question (SQ) and the Supportive and Palliative Care Indicators Tool (SPICTTM) for health and social care professionals, as well as a patient Question Prompt Sheet. Methods: A multi-method intervention study was conducted, including interviews and a pre–post survey of professionals on the development, implementation, and experiences with MINI. Interview data were analyzed inductively and survey data descriptively. Results: Data from 44 participants were included. MINI was generally considered acceptable and relevant, particularly the SQ, which prompted reflection among staff. Following the intervention, a significant improvement was observed in the presentation of regional specialist palliative care services for patients, as well as in the identification of psychosocial problems and their discussion with patients and relatives. While physicians reported increased confidence in initiating end-of-life conversations, other hospital staff showed mixed responses. Reported barriers for implementing MINI included limited time, the COVID-19 pandemic, staff strikes, emotional burden, and unclear responsibilities, indicating a low level of commitment. SPICT use was inconsistent, suggesting low integration into workflows. Interprofessional collaboration improved, particularly with external palliative care providers. Sustainability was hindered by a lack of institutional support, ongoing training, and formal routines. Conclusions: MINI may have the potential to shift the focus away from purely curative approaches. However, to guarantee success, future studies should ensure better alignment between intervention design, implementation and framework conditions.