# Diversity-sensitive palliative and hospice care in Germany – awareness, attitudes, and measures taken by service providers

## TL;DR

This study examines how German hospice and palliative care providers address diversity, finding that while awareness exists, few facilities have implemented specific diversity-sensitive measures.

## Contribution

The study provides new insights into the current state of diversity responsiveness in German palliative and hospice care through a large-scale survey.

## Key findings

- Most facilities recognized the importance of diversity but lacked dedicated structures like training or diversity officers.
- Barriers included organizational challenges, lack of knowledge, and insufficient financial resources.
- Written materials and communication-dependent services were not widely available to support diverse patient needs.

## Abstract

Studies have shown that needs and expectations concerning palliative and hospice care differ in relation to patients' diversity characteristics. Patients from minority groups may encounter various barriers that can prevent them from using or receiving appropriate, high-quality care. While corresponding measures and approaches exist that aim to address the diversity of patients, it is currently unclear, to what extent they are utilized by German palliative and hospice care facilities.

To examine the current state of sensitivity or responsiveness to diversity of German palliative and hospice care providers, a mixed-mode cross-sectional survey was conducted using a random sample (n = 1901) of German hospices, palliative care units in hospitals, outpatient hospice services, specialized palliative care teams (so-called ‘SAPV teams’), and other service providers listed in the online guide of hospice and palliative care services of the German Association for Palliative Medicine (DGP).

Among the respondents (n = 346, response rate = 18.2%), the majority perceived diversity responsiveness as a development that is gaining importance but did not necessarily consider addressing it in their facility. While a majority of facilities (56.9%) considered diversity in their mission statement, dedicated activities to promote diversity responsiveness – like diversity trainings for staff members (35.3%), designated diversity commissioners (4.6%), or dedicated internal working groups (4.3%) – were less common. Similarly, written materials and services depending strongly on communication were not generally available. Barriers to implementing such services were mostly related to organizational difficulties (31.8%), missing knowledge on how to implement corresponding measures (28.3%), and decision makers not being convinced of the necessity (25.7%). Furthermore, 25.1% of respondents reported lacking financial resources.

The surveyed palliative and hospice care facilities often did not address patient diversity sufficiently. Although a larger share of the respondents was generally aware of the need for diversity-sensitive care to improve patient orientation, corresponding structures and services were not commonly available. To address existing barriers, efforts to further raise awareness, as well as support measures to help facilities implement diversity-sensitive concepts are necessary.

The online version contains supplementary material available at 10.1186/s12904-025-01980-3.