Chapter 8 196 that patients and family can decide for themselves. This corresponds with Little et al.’s definition of patient-centred care: exploring patient ’s questions, understanding the patient within their context, enhancing the patient-clinician relationship and promoting health in line with the wishes of patients and family.33 Furthermore, non-specialist clinicians indicated that the question prompt list can be helpful in their practice. Because patient and family empowerment is desirable and warranted, the use of a question prompt list in palliative care is recommended. A question prompt list supports a proactive palliative care approach from a person-centred perspective, given that patient-related and clinician-related barriers are taken into account (Chapter 7, Table 3). This thesis demonstrates that the combination of the assessment of symptom burden and the assessment of information needs provides more opportunities for a personcentred and proactive approach than assessment of symptom burden or information needs alone. Use of the Leiden Guide on Palliative Care, which includes both, is therefore recommended in discussing and organising proactive palliative care. 8.3.3. Intention to produce good results and avoid (future) problems 1. Quality indicators for palliative care in patients with a haematological malignancy Palliative care, especially early palliative care, leads to favourable outcomes compared to standard care in patients with advanced diseases, such as improved quality of life and relief of symptom burden.42-49 These outcomes should be the goal of investing in producing good results and avoiding (future) problems. An example of a ‘problem’ that should be avoided is hospitalisation in the last months of life, because this can lead to aggressive or potentially inappropriate end-of-life care.50 Research has shown that not all end-of-life hospitalisations are necessary.51 Hospitalisations in the last three months of life can be avoided in 24%, according to general practitioners.52 Indicators for aggressive end-of-life care are described in more detail in Chapter 1. Indicators in the study on patients with cancer described in Chapter 4, by Earle et al., are the following: - Receiving chemotherapy in the last 14 days of life; - Starting a new chemotherapy regimen in the last 30 days of life; - >1 emergency room visit in the last month of life; - >1 hospitalisation in the last month of life; - Admission to the intensive care unit in the last month of life; - Death in an acute care hospital; - Lack of admission to hospice; - Admission to hospice <3 days before death.53, 54
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