Non-specialist palliative care - question prompt list preparation 141 QPL on palliative care, to identify information needs (Figure 1).4 Topics and questions were added to fit the Dutch healthcare system (see Supplement 1). The 2013 version of the QPL was used until the next iteration in October 2018. As part of their routine, the palliative care consultants provided the conversation guide to patients and family a few days before the consultation so that they could select topics to discuss. Patients and family were free to use (parts of) the conversation guide or not. Patients who did not have enough time to prepare for the consultation were either in an acute situation, physically too unfit or dying. Consultations in these situations are mostly aimed at managing a palliative care crisis or the dying phase. Therefore, these patients were not provided with the QPL. We estimate, from our clinical records, that patients and family used the QPL prior to the consultations in 22%. Study design This study evaluated the use of the QPL-part of the Leiden Guide on Palliative Care with a triangulation of qualitative research methods: thematic analysis of semi-structured interviews and audiotaped consultations. This study took place between August 2016 and December 2018. Participants and procedures Consultants of the hospital palliative care team sampled patients and family purposively (regarding diagnosis, age, and gender) to acquire a diverse sample for interviews about their experiences with the QPL (for the topic list, see Supplement 2). It was estimated beforehand that 15 interviews were needed to achieve data saturation. Patients were ineligible if they had not used the QPL, were not clinically fit to be interviewed or if the palliative care consultant estimated their life expectancy <3 months. After obtaining informed consent, a researcher (M-JV, BS, or DW-V) interviewed the patients after the consultation. Family were invited to take part in the interview or to be interviewed instead of the patient if the patient preferred so. Although we aimed at purposive sampling, we found that some patients and family were too exhausted to discuss the full QPL or did not remember in detail how they had used it. In these cases, we had to resort to convenience sampling regarding prognosis or physical functioning; additionally, we further gathered input from the patient and family’s perspective through patient and public involvement by interviewing three patient/family advocates from our regional palliative care consortium. These advocates had not used the QPL before and reviewed it before and during the interview. Clinicians were included for an interview if they had no formal palliative care training,22 but worked in a medical specialty providing care for patients in the palliative phase on a regular basis. To explore whether these non-specialist palliative care clinicians would support the use of a palliative care QPL and how they would use it, we included clinicians 7
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