Opportunities to improve palliative care: towards a more patient-centred and proactive approach

Verhoef, M.J. (2022)

Doctoral Thesis

This thesis aimed to find opportunities to improve proactivity and patient-centredness in palliative care, focussing on education and care outcomes. The 2009 national blueprint on medical education and the Dutch medical curricula did not comprise all essential elements about end-of-life care. Factors associated with approaching death in patients with advanced cancer visiting the LUMC’s Emergency Department (ED) in the last three months of life were lung cancer, neurologic deterioration, dyspnoea, hypercalcemia and jaundice. Patients with haematological malignancies received more potentially inappropriate care than advanced cancer patients. They rarely had limitations on life-sustaining treatments, although they often died of disease progression or treatment toxicity. The surprise question (SQ) is a simple tool to identify patients with palliative care needs . Adding poor performance status to the SQ improved the predictive value for one-year mortality in advanced cancer patients visiting the LUMC’s ED. The Leiden Guide on Palliative Care (LGP) was developed by the Centre of Expertise in Palliative Care to assess symptom burden and information needs. Patients and family wanted information about current problems and about their worries. Patients, family and clinicians found the LGP helpful. Using their input, the LGP was improved for use by generalist palliative care clinicians.

• Palliative care
• End-of-life care
• Emergency department
• Medical education
• Advanced cancer
• Oncology
• Haematological malignancy
• Question prompt list
• Patient-centred care
• Patient-centred communication

• All authors: Verhoef, M.J.
• Supervisor: Linden, Y.M. van der; Marijnen, C.A.M.
• Co-supervisor: Horeweg, N.
• Committee: Stiggelbout, A.M.; Beuken, M.H.J. van den; Achterberg, W.P.; Engels, Y.M.P.
• Qualification: Doctor (dr.)
• Awarding Institution: Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2022-11-23
• ISBN (print): 9789464587241