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

In hospital care for patients with serious illness, communication often remains focused on biomedical management, while patients’ goals and life circumstances are insufficiently integrated into care planning, increasing the risk of inappropriate care. Contextualising care integrates clinically relevant patient context into care planning but has not been evaluated in serious illness care. We assessed the (cost-)effectiveness of team training to improve healthcare professionals’ competence and delivery of contextualised serious illness care. A mixed-methods pre–post study was conducted among eight hospital teams involved in serious illness care in the Netherlands. The intervention consisted of two training sessions based on the 4 C contextual care model, adapted into a five-step process including contextual handover. Outcomes were assessed at four levels: (a) self-assessed competence (SCCS, EPCS and S-EOLC questionnaires), (b) applied competence (responses to simulated consultation videos ) , (c) implementation in clinical practice , and (d) healthcare use and costs (both assessed through medical record review). Secondary outcomes included job satisfaction and professionals’ perceptions of contextualising care, assessed through quantitative and qualitative measures. Questionnaires and video assessments were completed at baseline and 4 and 16 weeks post-intervention. Medical records of deceased patients from participating teams were reviewed for the year before and after the intervention. Eighty-one healthcare professionals participated; 87.7% attended both sessions and satisfaction was 8.3/10. Self-assessed competence improved significantly at 4 weeks post-intervention (SCCS + 0.28, EPCS + 0.25, S-EOLC + 0.47; all p ≤.001) and was largely sustained at 16 weeks, while job satisfaction remained stable. Qualitative findings supported these results, indicating fewer knowledge and skills barriers. Applied competence showed modest shifts towards cue-based, meaning-oriented, and patient-focused interpretations. Implementation in clinical practice demonstrated significantly increased documentation (87.9% vs. 98.6%, p <.001), anticipation of non-somatic issues (57.7% vs. 81.2%, p <.001), and handover within (16.4% to 27.9%, p =.021) and outside (25.0% to 36.4%, p =.038) the hospital. Healthcare costs, including allocated intervention costs, did not significantly change ( p =.858). Training hospital teams to contextualise care improved competencies and the documentation of relevant contextual information without increasing healthcare costs, offering a scalable route to embed person-centred and palliative principles in serious illness care within existing generalist teams. ClinicalTrials.gov, NCT07764263. Registered on 5 August 2026, (retrospectively registered)