Chapter 8 202 integration of end-of-life care and palliative care in the Dutch medical curricula.27, 29 To evaluate the effect of curricular interventions, it is preferable to measure the actual presence, knowledge, perceived importance and confidence again after implementation. An evaluation study on the presence of palliative care in the undergraduate medical curricula could be conducted by using a questionnaire or structured interviews among curricular programmers. Next, the effect of curricular changes should be measured using the methods of Chapter 2 or Pieters et al.27 EPAs (see 8.3.2.1), and competencies that are now added to the updated blueprint on medical education, can be used as primary outcomes in a cross-sectional survey or interview study in medical students who are about to finish their undergraduate medical studies. In this way, actual competence and experienced competence can be measured in young medical doctors, and opportunities for improvement of undergraduate education on palliative care can be identified. 2. Patient and family empowerment Patients and family indicated in Chapter 7 that the question prompt list of the Leiden Guide on Palliative Care (LGP) increased their sense of control. Future research should be aimed at how much the sense of control of patients and family increases after using the LGP in terms of feeling empowered to manage their illness. Self-management can be considered as the last station in person-centred care, according to Pulverenti et al.: Fig. 2. Person-centred care improves patient empowerment, which improves self-management in patients and family. Adapted from Pulvirenti et al.34 Lorig defined self-management as “learning and practicing the skills necessary to carry on an active and emotionally satisfying life in the face of a chronic condition”.93 The main goal of self-management interventions is supporting the patient to live and achieve those outcomes he or she wishes. Dineen-Griffin et al. created a model that supports clinicians in conducting self-management interventions during consultations in a person-centred way. Essential elements of this model are: • Provision of effective self-management support • Theoretical base to the intervention • Face-to-face multicomponent intervention with primary care provider • Tailored combination of self-management supporting strategies relevant to patient needs • Ongoing follow-up (face-to-face, telephone)
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