Background: When delivering palliative and end of life care in multi-organizational model, there is a risk of inadequacy of care. In Finland palliative care and end of life care has been determined to be a part of primary health care, assisted by specialized palliative and hospice
organizations in a need based three-level model. Organization of care are formulated in to care chains.
Aims: T o evaluate the Helsinki metropolitan area (HMA) palliative and end of life care chain and to improve practical implementation of the care chain in co-operation with professionals working in the care chain.
Methods: The stu dy was conducted as an action research. In the first cycle, the palliative and end of life care chain was described. In the second cycle the actors' views on the care chain principles and functionalities were evaluated (N33). Based on the second cycle's results, in the
third cycle the participants (N27) determined the focus for development. The collected data and results were produced by communicative group work and analyzed by qualitative content analysis.
Results: The HMA care chain is not equally known, does not have unified and determined values but actors' have a coherent value frame. The practice has improved but there are more challenges than strengths. The strengths are continuity, co-operation, homecare and increased knowledge. The challenges arise from timing, co-operation, features of the service structure and deficiencies in care delivery. The determined focuses for development are delivery of information, enhancing of knowledge and delivery and organization of care. The focuses were
formulated into the development frame sheet.
Conclusion: Development of the palliative an d end of life care chain requires networking, communication, organization and education. The results can be utilized in various care environments and areas by administrators, care organizations and individual professionals in
promoting and delivering palliative and end of life care.

Palliative and End of Life Care Chain: From Plan to Perfection