Strengths and limitations
This was an explorative, pre-implementation mixed-methods study, which requires the inclusion of all possible participants. In this study, information material was distributed to all division heads of the Department of Palliative Medicine who have passed it to their staff. About 2/3 of all employees did not partake in the study, possibly due to time constraints, lack of interest or positive attitude towards the intended university inpatient hospice. However, we explicitly asked about foreseen challenges and hurdles, so negative statements were welcomed and, in fact, expressed by participants. Due to the low number of participants who originated from the Department of Palliative Medicine of the University Hospital of Cologne only, the answers and especially the closed-ended question “need of a hospice” has to be interpreted with caution. This study is exploring healthcare professionals’ and volunteers’ perspectives who currently work in the Department of Palliative Medicine. We have therewith ensured the greatest level of heterogeneity with our sampling method, thus reducing bias, which we consider a strength, especially since sex and age were normally distributed. This does, however, clearly limit the generalizability. Therefore, this study should be followed by another qualitative study from the perspectives of palliative care patients, hospice residents, and their family caregivers as well as healthcare professionals from other departments of the university hospital Cologne, palliative care units, and hospices.To indicate trustworthiness of our results and enhance readability, representative quotations are presented for each sub-category. To enhance credibility and validity, the interview guide was meticulously discussed with research and clinical staff. We also ensured that the first author had the required knowledge and training to perform the study.