General discussion 209 The PASEMECO toolbox and integral palliative care course are examples that can be useful for curriculum programmers and teachers to optimise the curricula.27, 100 Among other aims (see 8.3.2.1), O2PZ is committed to supporting curriculum programmers in integrating palliative care into the packed medical curricula. In this way, palliative care education can be integrated in a way that suits the local curricula, and in coordination with curriculum programmers. It may be difficult to persuade curriculum programmers to make space for palliative care education. A suggestion to discuss with curriculum programmers is that all medical doctors should have generalist palliative care competences, because the palliative care demand will increase (see Chapter 1), and these generalist competences are described in the Quality framework on palliative care.19, 20, 25 Measuring and evaluating the quality of undergraduate medical education can result in better anchoring of palliative care in the curricula (see 8.4.1.1). Therefore, regular evaluation of undergraduate medical curricula is not only needed for research purposes, but also to guard the preparation of medical students for their future work, including generalist palliative care competences. 2. Patient and family empowerment The Leiden Guide on Palliative Care (LGP), a palliative care conversation guide, combines assessment of symptom burden with assessment of information needs. Using feedback of patients, family and clinicians in Chapter 7, an instruction leaflet was developed (Supplement 7 of Chapter 7) in order to support clinicians in using the question prompt list appropriately and optimally. This instruction leaflet can be used in training and education about the empowerment of patients and family during individual conversations about palliative care. Good training in using the LGP is necessary since use of the question prompt list may evoke strong emotions in patients and family (Chapter 7), even though they expect to talk about difficult questions cohering to the phase of their illness. Chapter 6 demonstrated that symptom assessment alone is not sufficient to explore what topics patients worry about. It seems that patients and family want to know more about the future and how they can manage the illness themselves. From the results of this thesis follows that the LGP can be supportive in both assessing (information) needs, and providing person-centred advice appropriate for the phase of their illness. The use of a combination of a symptom assessment with a question prompt list in clinical practice is recommended. A side outcome of this thesis is the uncertainty patients, family, lay people, but also clinicians, may experience about what palliative care actually entails. Appropriate and sufficient education of clinicians, patients and family is essential when reflecting on the core principles of proactive palliative care: 8
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