Chapter 8 186 Objective 3: To describe the end-of-life trajectory and quality of care of patients with a haematological malignancy who visited the ED in the last three months of their lives, compared to patients with advanced cancer. Patients with a haematological malignancy often receive more aggressive end-of-life care than patients with a solid tumour. Insight into cues for proactive care can help improving ED-triggered palliative care in patients with a haematological malignancy. Chapter 4 presents a mortality follow-back study in 78 patients with a haematological malignancy and 420 patients with a solid tumour visiting the ED in the last three months of life. Before their ED-visits, patients with a haematological malignancy had less often discussed limitations on life-sustaining treatments. Since their ED-visit, patients with a haematological malignancy were more often hospitalised after their ED-visit, received more aggressive end-of-life care, and more often died in-hospital, in the intensive care unit or in the ED, compared to patients with a solid tumour. Objective 4: To evaluate the performance of the surprise question to identify palliative care needs in patients with advanced cancer visiting the ED. The Surprise Question (SQ), ‘ ‘Would I be surprised if this patient died in the next 12 months?’ ’, is an instrument to identify patients with palliative care needs. A meta-analysis of Downar et al. demonstrated that the SQ lacks sensitivity and may be more accurate when combined with other indicators of palliative care needs. Chapter 5 describes an observational cohort study in 245 patients with advanced cancer visiting the ED in 2013 and 2014. The SQ had the following test characteristics: sensitivity of 89%, specificity of 40%, positive predictive value of 85%, negative predictive value of 50% and a c-index of 0.56. In patients in whom physicians would not be surprised if they died within one year, ECOG performance status 3-4 was an independent predictor for approaching death. Addition of ECOG performance status 3-4 as a second step to the SQ improved the c-index (0.65), specificity (92%) and positive predictive value (95%) at cost of sensitivity (40%) and negative predictive value (29%). Objective 5: To explore the association between symptom burden and information needs of patients referred to a hospital palliative care consultation team using the Leiden Guide on Palliative care (LGP). The LGP is a conversation guide on palliative care consisting of two parts. The first part comprises the Utrecht Symptom Diary, a translated and adapted Edmonton Symptom Assessment Scale.1 The second part is a question prompt list on palliative care, a Dutch adaption of the version developed by Clayton et al.2 The relationship between patientreported symptom burden and information needs has not been studied before. Chapter
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