Chapter 1 24 6. AIMS AND OUTLINE OF THIS THESIS The studies presented in this thesis reflect bottlenecks that were identified by our palliative care consultation team through their clinical experience since 2011. Additional bottlenecks were identified through quality-of-care evaluations and surveys that were held in Leiden University Medical Center to assess barriers and facilitators to hospital palliative care.133 Important bottlenecks that were subject to research and are included in this thesis were: • Palliative care education needs expressed by generalist clinicians • Unnecessary and preventable healthcare transitions to the emergency department (ED) • Patients and family being unaware of their palliative care and information needs The aim of this thesis was to find opportunities to improve proactive palliative care by providing insight in: • Current Dutch medical education; • Timely identification of patients with palliative care needs; and • Ways to support patients, their family, and clinicians to tailor conversations about palliative care. The studies in this thesis included input from patients and their family, and from professionals from the field of education, clinical practice, and research. The research objectives of the studies in this thesis were the following: 1. To assess the extent to which end-of-life care is taught at medical schools in the Netherlands and to find opportunities to improve Dutch medical curricula. 2. To explore palliative care needs and the extent of proactive care in patients with advanced cancer who visited the ED in the last three months of their lives. 3. To describe the end-of-life trajectory and quality of care of patients with a haematological malignancy who visited the ED in the last three months of their lives, compared to patients with advanced cancer. 4. To evaluate the performance of the surprise question to identify palliative care needs in patients with advanced cancer visiting the ED. 5. To explore the association between symptom burden and information needs of patients referred to a hospital palliative care consultation team using the Leiden Guide on Palliative care (LGP). 6. To evaluate and further develop the question prompt list of the LGP to prepare the question prompt list for use by generalist palliative care clinicians. Chapter 2 (aim 1) discusses the integration of end-of-life care in Dutch medical curricula. End-of-life care was chosen instead of palliative care because sufficient end-of-life care
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