Chapter 1 22 USD – 4 dimensional (USD-4D).99 The USD-4D is congruent with the Ars Moriendi model developed by Carlo Leget, which is depicted as a diamond existing of five continuums that represent aspects of dying.100 The content of the USD-4D is validated from the perspective of patients.99 According to IKNL’s selection in Table 2, only the Lastmeter would suffice in identifying patients who have palliative care needs in all four palliative care dimensions. The new USD-4D will probably be added to this list as it is content-validated and includes the four palliative care dimensions.99 4.2 Assessment of information needs It is necessary to assess the needs of patients and family in order to support them. A study using the Dutch Potential problems and Needs for Palliative Care (PNPC) questionnaire found that patients indicate different items they experience as a problem and items they wanted professional attention for.101 The authors concluded that problems are not the same as unmet palliative care needs. Assessment of palliative care needs of patients and their family should also include assessment of their information needs, and of how they cope with their prospects. Additionally, patients and their family need support in remembering what was explained during consultations.102-106 While patients and their family have information needs about palliative care, they are often unaware of the questions they can ask during palliative care consultations.106, 107 Lack of knowledge about palliative care and insight into their information needs impedes their sense of selfefficacy and may result in a sense of loss of control over their lives.108, 109 For healthcare professionals, it is essential to communicate effectively to acquire insight in the palliative care and information needs.110-112 Information-provision to patients with an advanced disease and their family stimulates self-management and supports coping with the disease now and in the future.113 A study by Temel et al. in 2017 showed that end-of-life preferences were discussed more often in patients who received palliative care plus standard care, versus standard care alone. This implies that application of a palliative care approach encourages discussions about the needs, wishes and values of patients and their family.114 During palliative care needs assessments, generalist palliative care healthcare professionals often do not inquire their patients thoroughly enough. They mostly focus on the physical dimension, and often do not assess information needs.115, 116 Question prompt lists are structured lists with sample questions patients and their family may ask during conversations with their clinician and to share information needs.117 Patients and their family are asked to prepare their palliative care consultation by indicating which questions they would like to ask. Most question prompt lists are used in patients with (advanced) cancer.118-130 Studies about these oncology question prompt lists have shown that patients find question prompt lists helpful, that they ask more
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