Non-specialist palliative care - question prompt list preparation 143 who had not used the QPL before (Figure 2). Clinicians were purposively sampled via the Center of Expertise in Palliative Care’s network until a diverse sample was reached regarding profession, medical specialty, years of working experience and working in or outside the hospital. A researcher (BS) interviewed the clinicians; 15 interviews were planned to achieve data saturation. Consultants of the hospital palliative care team selected consenting patients and family to audiotape their consultations with a palliative care consultant to explore which topics were addressed. Both patients who had used a QPL and patients who had not used it were included. To evaluate how the QPL was used during consultations, only consultations of patients who had used the QPL were included. To evaluate what topics had been addressed during consultations but are not listed in the QPL, also consultations in which patients had not used the QPL were included. Further development of the QPL The QPL was iteratively adapted based on suggestions made by the interviewees, findings from the audiotaped consultations and grey literature (Figure 2). The first revision was done after analysing all consultations, interviews with clinicians and five interviews with patients and family. We aimed to revise the QPL iteratively after each set of five interviews with patients and family, until no additional suggestions emerged from the interviews. Adaptations were made in consecutive research meetings with three palliative care physicians (two general practitioners, and one elderly care physician), two clinical nurse specialists in palliative care, two specialised nurses in palliative care and three researchers. Data analysis A trained research assistant transcribed the interviews and consultations verbatim and de-identified all data. Two independent researchers coded the transcripts of the interviews inductively (BS and M-JV: interviews with clinicians; DW-V and M-JV: interviews with patients and family), adhering to Braun and Clarke’s method for thematic analysis.21 Interviews were analysed thematically to explore user experience and usefulness of the QPL during the consultations, and to assess whether topics were missing in the QPL and what should be changed about the QPL. Themes were finalised in consensus meetings and were categorized using a code tree. For content analysis of the audiotaped consultations (BS and M-JV), a coding scheme was developed (AHP and BS) to code: (1) which topics from the QPL were addressed during consultations; and (2) the person who initiated the discussion of a topic (patient, family, or clinician). A category was considered to have been selected, addressed, or initiated if one of the underlying topics had (Figure 1, Supplement 1). Frequencies are reported using descriptive statistics. 7
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