Summary 223 This chapter includes a summary of the main findings presented in this thesis. A Dutch summary (‘Nederlandse samenvatting’) can be found in the Appendices. CHAPTER 1. GENERAL INTRODUCTION A palliative care approach aims to “improve the quality of life of patients and their families facing the problem associated with a life-threatening illness or frailty, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritual.”1 Palliative care should be integrated into standard care early in the trajectory of patients with a potential life-limiting illness to timely prepare them and their family on how to continue living their lives while the end of life may be near.2 Integrated palliative care is associated with a better quality of end-of-life care compared to standard care alone.3-5 According to the 2018 Lancet Commission on Palliative Care and Pain Relief, serious health-related suffering will increase worldwide: in 2060, 47% of all people will die after going through serious health-related suffering.6 This underlines the importance of appropriate and timely initiation of palliative care. In the Netherlands, palliative care is organised according to the generalist-specialist palliative care model.7, 8 This means that every clinician working with patients should have basic knowledge and skills in providing palliative care, and that they can ask specialist palliative care clinicians for support in complex cases. It is therefore warranted that knowledge and skills are adequately provided and acquired during (medical) education. Previous Dutch evaluations have demonstrated that 30% of the medical doctors had insufficient knowledge about pain treatment, and that 83% of the medical doctors would appreciate additional education about opioid and pain treatment and about palliative sedation.9, 10 Knowledge and skills regarding palliative care had not been assessed in detail yet in Dutch undergraduate medical students. Generalist palliative care clinicians should be trained in identifying patients who can benefit from a palliative care approach. This includes the recognition of ‘trigger moments’, which are events that mark deterioration or increased need of palliative care. Recognition of ‘trigger moments’ allows clinicians to consider goals of care and to discuss these with patients and family.11 An important example trigger moment is when patients with a potentially life-limiting illness visit the Emergency Department (ED): ED-triggered palliative care. It is known that patients who had received ED-triggered palliative care had a better quality of life than patients who received standard care.12, 13 9
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