Non-specialist palliative care - question prompt list preparation 145 RESULTS Thematic saturation on the use of the QPL and suggestions for improvement of the QPL was reached after 18 interviews with patients and family (including the three patient/ family advocates), and 17 interviews with clinicians (Table 1). Of the 33 audiotaped consultations, one recording was excluded from analysis because of poor quality (Table 2; for patient characteristics, see Supplement 3). Three iterations of the QPL were made based on the data; after the third round of interviews with patients and family, no new suggestions to improve the QPL emerged (Supplement 4 and 5). Use of the QPL among patients and family Patients and family described the QPL as helpful: its content raised awareness about what palliative care and a palliative trajectory entail. It structured their thoughts about their situation, problems, and questions. “It is a very good summary of what might be coming your way. (…) It provides an overview.” (patient 13) They appreciated that the QPL presented topics that they had not thought about before, supported their thinking about what questions they may have, and that it invited them to talk about it. “About hospice care, for example, I have never talked about that before, or even thought about it.” (patient 1) “I found it illuminating to have a list of topics that can be discussed. And presenting the different topics also makes you think about the questions you may have.” (daughter of patient 4) “I think that this could clearly contribute to an improved relationship between patient and clinician. (…) Because the patient and next of kin often experience a threshold towards a clinician. Um, like: can and am I allowed to ask this.” (patient 12) It could also inspire patients and family to think about topics specific to their situation, even if they were not mentioned in the QPL. The QPL could further evoke discussions between patients and family members: 7
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