Background: The number of persons with life-threatening illnesses who need palliative care is expected to increase as people are living longer, due to advances in medical treatment and technology. Access to palliative care with inherent required competencies varies greatly leading to unequal availability and quality of end of life care. There are major shortcomings in palliative care and regional differences in accessibility, quality, symptom relief, involvement and support for close relatives. Evaluation of quality of care (QoC) is important to guide improvements and the use of healthcare professionals’ (HCP) perspective means that fragile patients and their close relatives are not burdened.

Aim: To investigate how HCPs in palliative care perceive quality of care regarding perceived reality (PI) (given care) and subjective importance (SI) (how care should be). 

Method: Cross-sectional study with descriptive and analytical design. Data were collected February 2018 with the four dimensional questionnaire Quality from the Patient’s Perspective specific for Palliative Care - personnel (QPP-PC) among HCP in a combined acute oncology-palliative care unit (total survey) in Sweden. Response rate of 53 % (n=41). 

Results: HCP scored statistically significant higher regarding subjective importance compared to perceived reality (p≤ .00) in all four dimension; medical-technical competence, physical-technical conditions, identity-oriented approach and sociocultural atmosphere. Information (PR mean 2.78 SD .57; SI mean 3.66 SD .34; p≤ .00), participation (PR mean 2.84 SD .70; SI mean 3.52 SD .54; p≤ .00), continuity (PR mean 2,61 SD .74; SI mean 3,34 SD .59; p≤ .00), and spiritual/existential needs (PR mean 2.73, SD .64; SI mean 3,34, SD .87; p≤ .00) were factors where respondents scored lowest values in PR compared to SI. Cronbach´s α-values in dimensions and factors were moderate to high. 

Conclusion:  These findings highlight palliative QoC problems in units with mixed care focus, i.e. acute, supportive and end of life care. Strategies to ensure PC when needed has to be developed and implemented in acute care settings to avoid futile interventions.