Public health actions to improve palliative care in Germany: results of a three-round Delphi study.
BACKGROUND
In previous studies, key targets for public health initiatives to improve palliative care in Germany were defined. The aim of this study was the identification and prioritisation of actions to achieve these targets.


METHODS
A three-round Delphi study with 107 stakeholders acting on the meso and macrolevel of the healthcare system was undertaken. First round: proposing actions for each of the key targets; second round: assessment of the actions regarding their relevance; third round: ranking of the actions.


RESULTS
37 actions were generated (first round) of which 14 actions were rated as relevant (second round). In the third round, the action ranked highest was "close collaboration between specialist palliative care services, general practitioners and community nursing services", followed by "Implementing specialist palliative care in the community consequently" and "Strengthening generalist palliative care through training and education of general practitioners and nursing services".


CONCLUSIONS
The range and the ranking of the actions provide an empirical basis to improve palliative care in Germany on different levels of policy, education and clinical practice. A focus should be on strengthening the collaboration between primary health care providers and specialist palliative care services.