General introduction 25 education is vital to improve palliative care education. Based on literature review, a checklist was made comprising of elements that are essential in undergraduate medical education. Using this checklist, we assessed the National Blueprint on Medical Education, the bachelor, and master curricula of all eight medical faculties of the Netherlands and their elective courses in 2016. In Chapter 3 (aim 2), disease and visit characteristics are described of 420 patients with advanced cancer visiting the ED between 2011 and 2013. Possible predictors for approaching death were analysed to support screening for urgent palliative care needs at the ED. Chapter 4 (aim 3) presents the end-of-life trajectories of 78 patients with a haematological malignancy visiting the ED in the last 3 months of life. The quality indicators of Earle et al. were used to describe the quality of end-of-life care provided to patients with a haematological malignancy.13 A comparison was made with 420 patients with a solid tumour. The test characteristics of the surprise question are studied in Chapter 5 (aim 4). An observational prospective cohort study was conducted in 245 patients with advanced cancer who visited the ED in 2013 to 2014. Other predictors for approaching death were tested, and we evaluated whether addition of these predictors improved the test characteristics of the Surprise Question. Chapter 6 (aim 5) provides an overview of the symptom burden and information needs of 321 patients referred to a hospital palliative care consultation team, using data from Leiden Guides on Palliative Care collected between 2013 and 2018. The association between symptom burden and information needs was studied. The evaluation and further development of the Leiden Guide on Palliative Care was carried out from 2017 to 2019 and is described in Chapter 7 (aim 6). Qualitative methods including thematic analysis of 35 semi-structured interviews and open coding of 33 recorded consultations were used to acquire input from patients, their family, and clinicians. Chapter 8 concludes this thesis with a general discussion of how our findings can improve proactive palliative care, and provides recommendations for future research, education, clinical practice, and policy. 1
RkJQdWJsaXNoZXIy MTk4NDMw