Non-specialist palliative care - question prompt list preparation 151 Barriers to QPL use Patients, family, and clinicians identified several barriers to using the QPL (Table 3). Some patients and family indicated that they had not been properly informed yet about their disease phase or the concept of palliative care, or that they had not thought about it; this made them unprepared for some topics presented in the QPL. Other reported barriers were not being able to use the QPL because of lack of space, time, and energy to go through the QPL and not having a trusting relationship with their clinician to discuss delicate topics. Three patients were unable to emotionally relate to the palliative care topics; they found them too challenging and skipped the sections they thought did not apply to them. Nonetheless, they understood these topics would become important at some point or may already be relevant to others and they felt it was right that the topics were part of the QPL. Optimal use of the QPL was further thought to be impeded Table 3. Barriers to use, value of the question prompt list, and recommendations for clinicians Barriers to use and value Recommendation for clinicians Patient-related barriers Patient cannot identify himself as being palliative Introduce concept of palliative care to patient and family Explain what the QPL is: it is a tool providing insight into symptom burden and information needs that can be discussed during a consultation about palliative care Explain how the QPL can be used: irrelevant or unsettling parts can be skipped Patient is not able to use the QPL • Not enough space, time, and energy to think over and fill out • Decreased cognitive ability, unable to comprehend Family can fill out the QPL if the patient is not able to use it Hand out the QPL at least several days before the consultation takes place Clinician-related barriers Not sure if the QPL can be handed out to every patient in the palliative phase The QPL can be used for all patients in the palliative phase and their family Going through the QPL may take too much time More than one consultation can be scheduled to discuss the QPL Ask the patient at the beginning of the consultation what he or she considers the most important topic to discuss Not sure which clinician should discuss the QPL Refer to another clinician or healthcare professional when topics are outside the field of expertise of the clinician or in case time is lacking: nurse specialist, psychologist, social worker, spiritual counsellor List of abbreviations: QPL, question prompt list 7
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