The study, led by Linda Modderkolk of the Department of Anaesthesiology, Pain and Palliative Medicine at Radboudumc in Nijmegen, together with colleagues from geriatrics, intensive care medicine and independent research, set out to evaluate something that had not previously been assessed in serious illness care: the effectiveness of training hospital teams to contextualise care. Contextualising care means integrating clinically relevant patient context, such as a patient’s values, social situation and anticipation of non-somatic problems, into care planning. The researchers assessed both the effectiveness and the cost-effectiveness of team training designed to improve professionals’ competence and their delivery of contextualised serious illness care.

The intervention itself was built on the 4C contextual care model, adapted into a five-step process that included contextual handover, the deliberate transfer of relevant patient context between professionals and between care settings. Eight hospital teams involved in serious illness care in the Netherlands took part in the evaluation. The training consisted of two sessions, and the programme was evaluated across four distinct levels of outcome: self-assessed competence, applied competence measured through responses to simulated consultation videos, implementation in clinical practice assessed through medical record review, and healthcare use and costs, also derived from medical records.

Eighty-one healthcare professionals participated in the study, and attendance was strikingly high: 87.7 percent attended both training sessions, and satisfaction with the training averaged 8.3 out of 10. Questionnaires and video assessments were completed at baseline and again at four and sixteen weeks after the intervention. The researchers used three validated instruments to measure self-assessed competence: the Spiritual Care Competence Scale, the End-of-Life Professional Caregiver Survey, and the Self-Efficacy in End-of-Life Care scale. Job satisfaction and professionals’ perceptions of contextualising care were captured through quantitative and qualitative measures.

The results on competence were clear and statistically robust. Self-assessed competence improved significantly at four weeks post-intervention, with the Spiritual Care Competence Scale rising by 0.28, the End-of-Life Professional Caregiver Survey by 0.25, and the Self-Efficacy in End-of-Life Care scale by 0.47, all with p-values at or below 0.001. These gains were largely sustained at sixteen weeks, suggesting that the training produced durable changes rather than a short-lived enthusiasm effect. Job satisfaction remained stable throughout, indicating that the added expectations did not burden professionals. Qualitative findings supported the quantitative results, with participants reporting fewer knowledge and skills barriers to contextualising care.

Applied competence, a more demanding test of whether professionals could actually use what they had learned, showed more modest shifts. When responding to simulated consultation videos, participants moved towards cue-based, meaning-oriented and patient-focused interpretations of the consultations. In other words, they became better at picking up contextual cues in the conversation and interpreting them in terms of the patient’s meaning and focus rather than defaulting to purely biomedical readings. The researchers describe this as a shift in interpretation style, one that complements the larger gains seen in self-assessed competence.

Perhaps the most consequential findings concern what actually changed in clinical practice. The medical records of deceased patients from the participating teams were reviewed for the year before and the year after the intervention, providing an objective window into documentation and care delivery. Documentation of relevant contextual information increased significantly, from 87.9 percent to 98.6 percent of records, with p less than 0.001. Anticipation of non-somatic issues, meaning attention to problems beyond the physical body such as psychosocial or existential concerns, rose from 57.7 percent to 81.2 percent, also with p less than 0.001. Contextual handover within the hospital increased from 16.4 percent to 27.9 percent, with p equal to 0.021, and handover outside the hospital rose from 25.0 percent to 36.4 percent, with p equal to 0.038.

Crucially, none of these improvements came at a financial premium. Healthcare costs, including the allocated intervention costs, did not significantly change, with a p-value of 0.858. This is a technically important result for health services research, because interventions that improve person-centred care often carry hidden costs in staff time, training resources and additional consultations. The finding that contextualised care can be embedded in existing generalist hospital teams without increasing costs offers a scalable route to person-centred and palliative principles in serious illness care, a conclusion the authors highlight explicitly in their paper.

The study was supported by a grant from ZonMw, the Netherlands Organisation for Health Research and Development, project number 10200012110008, with the funder having no role in the design, conduct, analysis, interpretation or reporting of the study. The work was conducted in accordance with Dutch legislation and the principles of Good Clinical Practice, and the Medical Review Ethics Committee Oost-Nederland determined that the study did not fall under the Medical Research Involving Human Subjects Act, under reference number CMO 2023-16760. Written informed consent was obtained from all participants, and the medical record review proceeded only after local institutional review and authorisation procedures were completed through the research offices of the participating hospitals, with data transfer agreements concluded and all collected data anonymised prior to storage and analysis.

The evaluation was retrospectively registered on ClinicalTrials.gov under identifier NCT07764263 on 5 August 2026, and the article was published open access on 23 September 2026 under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International licence. Taken together, the findings present a technically grounded case that a two-session team training based on the 4C contextual care model, adapted into a five-step process including contextual handover, can shift hospital teams towards more person-centred serious illness care. The improvements in documentation, anticipation of non-somatic issues and contextual handover, combined with sustained competence gains and stable costs, suggest that embedding palliative and person-centred principles within existing generalist teams is achievable with modest training investment, offering hospital systems a practical and evidence-based pathway forward.

Subject of Research: Health Services Research

Article Title: Training hospital teams to contextualise serious illness care: a mixed-methods evaluation

Article References: Modderkolk, L., Schoon, Y., Touw, H. R. W., Nijman-van Erven, J. E. M., Engels, Y., & Wichmann, A. B. (2026). Training hospital teams to contextualise serious illness care: a mixed-methods evaluation. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15653-1

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15653-1

Keywords: palliative care, serious illness, contextualised care, hospital teams, communication training, patient-centred care, health services research, mixed methods, medical record review, ZonMw, Training, hospital