General discussion 213 Prevention can occur during individual consultations, but also on meso- and macro-level. The discussion about the prevention of unwanted outcomes can be initiated upfront, for example in healthy individuals: how do you wish your dying phase would look like, and what does absolutely not match how you want to die? Discussions about future scenarios can however take place at any time during an illness trajectory, since at any time unwanted outcomes can be prevented if discussed with patients and their family. CONCLUSION Proactive palliative care includes three core principles: promotion of knowledge and selfinitiation in the triad of clinician, patient, and family; the intention to produce good results and avoid (future) problems; thinking ahead to be able to act before things happen. This chapter outlined which opportunities for improving proactive palliative care are provided by this thesis: the need for quality palliative care education for clinicians, improvement of patient and family empowerment, quality indicators for end-of-life care, timely identification of palliative care needs, and a two-track approach for timely discussions about palliative care and future scenarios. 8
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