Chapter 8 192 good quality palliative care is proactive rather than reactive. A proactive attitude is preferred to prevent problems and suffering in the (near) future. • to avoid (future) problems, i.e., to avoid poor quality of the last phase of life. A poor quality of the last phase of life includes unnecessary symptom burden, caregiver burden and inappropriate care. Inappropriate care is associated with insufficient supportive care, overtreatment and insufficient symptom relief, hospital care, not following wishes of the patient, and poor communication (mainly informing insufficiently and not-listening).23 Taking the aforementioned concepts and definitions of proactivity and palliative care into account, the following themes can be identified, with the following recommendations articulated in this thesis: Theme Subthemes addressed in this thesis 8.3.2 Promoting knowledge and selfinitiation in clinicians, patients, and family 1. Good education for undergraduate medical students 2. Patient and family empowerment 8.3.3 Intention to produce good results and avoid (future) problems 1. Quality indicators for palliative care in patients with a haematological malignancy 2. Timely identification of palliative care needs: ED-triggered palliative care in patients with advanced cancer 8.3.4. Thinking ahead to be able to act before things happen 1. A two-track approach 2. Discussing future scenarios The next sections will discuss how the studies included in this thesis contribute to the concept of proactive palliative care, and which recommendations can be made based on this thesis. 8.3.2 Promoting knowledge and self-initiation in clinicians, and patients and family 1. Good education for undergraduate medical students (partly adapted from de Bruin et al. NED TIJDSCHR GENEESKD. 2020;164:D4115)24 In the Netherlands, provision of palliative care is organised following the generalist – specialist palliative care system.25 This means that all clinicians should have at least basic palliative care competences. These responsibilities are described in the Netherlands Quality Framework for Palliative Care 2017.19 Furthermore, a publication in JAMA about the need for appropriate palliative care during the COVID-19 pandemic, reminded that palliative care is a human right, and that patients without curative options should not be abandoned.26 The study in Chapter 2 addressed undergraduate medical education.
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