Non-specialist palliative care - question prompt list preparation 157 other life-limiting diagnoses. However, by asking patient advocates who had a loved one who had died and who had not used the QPL before, we believe we overcame these gaps introduced by selection bias through interviewing those who used the QPL and through a life expectancy of at least 3 months. Further research Our study included mostly patients with cancer, similar to most studies on QPLs in palliative care.15,36 Before implementing the QPL for use by non-specialist palliative care clinicians, qualitative research is needed on how they experience use of the QPL in clinical practice: the effect of using the QPL, facilitators and barriers to using the QPL effectively and how much training is required for them to use the QPL appropriately. Next, a study with cluster-randomised design in non-specialist clinicians can indicate its effect on patient outcomes. We also recommend further research on whether the interviewees’ suggestions are sufficient in improving person-centred communication and patient empowerment. We studied the use of a QPL as a strategy to improve consultations with individual patients and family. Wider and systemic implementation should be preceded by clinical trials evaluating its effect in other patient populations and healthcare settings, such as in general practice and nursing homes. Future research aims include examining the effect of combining a symptom assessment scale and a QPL on perceived quality of care, and the effect of QPLs on patient autonomy and quality of life. CONCLUSION Patients and family considered the QPL to be relevant, clear, and comprehensive. The QPL was thought to support patients and family in structuring their thoughts and in formulating and asking their questions. They felt better prepared for their current situation and the future. Clinicians can use the QPL as an overview of topics relevant in palliative care and to tailor consultations to the needs of patients and family. Although the QPL could evoke negative emotions, patients and family understood the necessity and usefulness of discussing these topics. Reported barriers to optimal use were insufficient introduction of patients and family to palliative care and to the QPL, patient lack of time and energy to use it, and patients not relating the topics integral to palliative care to themselves. Acknowledgements The authors would like to thank all participants for their time and input, Tanja Klos, Els Roelofs, Inge van Mansom, Carla Juffermans, Jeanet van Noord, Marleen Oomes and Simone Schoof (experts of our palliative care consultation team) for sharing their 7
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