Identifying the factors contributing to hospital readmissions in palliative care: a mixed-methods study from a Turkish palliative care unit

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BACKGROUND: Palliative care is a comprehensive approach that aims to improve quality of life and reduce symptom burden in life-threatening illnesses. However, hospital readmissions in these patients are a significant problem for both the healthcare system and patients and caregivers. The aim of this study was to identify the factors leading to these hospital admissions and develop recommendations to inform preventive care approaches. METHODS: The study utilized an explanatory sequential mixed-methods design. In the first phase, we retrospectively analyzed the clinical and demographic data of 1,256 patients receiving palliative care between 2016 and 2025 using normality tests (Kolmogorov–Smirnov, Shapiro–Wilk), group comparison tests (t-tests, ANOVA), Pearson correlation, and multiple regression analysis. In the second phase, data obtained from semi-structured interviews with 14 patients, 14 caregivers, and 17 healthcare professionals were analyzed thematically using the MAXQDA 2024 program. RESULTS: In quantitative analyses, disease type (p = 0.005), number of additional chronic diseases (p < 0.001), and age (p = 0.028) were significantly associated with hospital readmissions. Hospital admission frequency was significantly higher among individuals diagnosed with Chronic Obstructive Pulmonary Disease (COPD), while the length of hospital stay was significantly higher among individuals diagnosed with stroke and Alzheimer’s disease. Qualitative analysis identified three main themes: Perceptions of Care Quality, Anxieties and Fears, and Systemic Challenges. CONCLUSIONS: Preventing hospital readmissions in palliative care requires a comprehensive approach that addresses not only medical factors but also psychosocial and systemic factors. In this context, the findings point to key components that may inform the development of future nurse-led, sustainable care approaches, including early palliative care interventions, home care training, counseling services, and consistent home visits.