Relational care in palliative care units: a qualitative study of low-threshold volunteer hospice conversations

Palliative care aims to address psychosocial needs alongside medical treatment. In inpatient settings, however, organisational constraints may limit opportunities for sustained relational support. Volunteer-based conversation offers represent a potential service-level response to these gaps, yet little is known about how such low-threshold models are implemented and experienced within routine inpatient care. This qualitative descriptive interview study explored the experiences of twelve trained volunteer hospice companions involved in a low-threshold conversation offer on two palliative care units in Germany. Semi-structured individual interviews were analysed using qualitative content analysis following Kuckartz, with inductively developed categories and independent double coding. Volunteers described the conversations as a distinct relational care practice grounded in presence, attentiveness and deliberate restraint rather than intervention. Care was enacted through responsiveness to patients’ momentary needs, including respect for silence, refusal and non-verbal interaction. The ward-based interdisciplinary setting and effective symptom control were perceived as key enablers of psychosocial conversations, while the rotating and low-binding format entailed specific emotional and organisational demands, underscoring the importance of supervision and role clarity. Low-threshold, non-prearranged volunteer conversations represent a distinct relational care practice in hospital palliative care. They may support autonomy and dignity through non-imposition and situational responsiveness, and they highlight the ethical responsibility of institutions to provide structural support, supervision and clearly defined roles for volunteers.