Assessment of symptom burden and information needs helps tailoring palliative care consultations 123 Strengths and weaknesses To our knowledge, this is the first study to explore the relationship between symptom burden and information needs, and the differences between patients in the diseasemodifying phase versus symptom-management phase, referred to a hospital-based palliative care team. The results of this study may not apply to all patient populations referred to hospital-based palliative care, because it was conducted in an academic medical centre and almost all patients had cancer. The palliative care consultant assesses whether a patient is fit enough to go through the conversation guide, excluding patients in the dying phase. Therefore, this study does not report on symptom burden and information needs of these patients and their families. Patients reported their symptom burden and information needs at the same time. The fact that symptom burden was assessed first in the conversation guide, followed by information needs, may have influenced reported information needs about symptoms; these information needs may have been less had the order been reversed. Since patients and families received only one conversation guide before the consultation, it was not possible to distinguish patient from family needs. However, the information needs of both are relevant in palliative care consultations. The data, although collected some years ago, are still relevant because information provision by clinicians has not changed substantially. Further research Our study was conducted among patients of a specialist palliative care team at an academic hospital. In future research, symptom burden and information needs should be assessed in other settings and among patients with a non-cancer diagnosis. Ways to address intimacy and sexuality in palliative care could be further explored. We did not study if patient-reported symptom burden and information needs altered over time, which would be an interesting topic for further research. Future research could study the effect of using a symptom assessment scale combined with a question prompt list on quality of life and person-centred care. This study was conducted using an observational study design in patients who have used the conversation guide. More precise insight into the symptom burden and information needs of patients in palliative care in several care settings can be provided by using a prospective follow-up design in a cohort of patients who have all received the conversation guide. Additionally, reasons for (not) using the conversation guide can be tracked. Also, the use of the conversation guide in the dying phase in identifying the needs of family of patients can be studied. 6
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