PhD defence A. ( Annemieke) van der Padt - Pruijsten

Brief summary of the doctoral thesis:

Palliative care aims to improve the quality of life of patients and their families dealing with the problems associated with an incurable disease, such as advanced cancer. Palliative care includes shared decision making (SDM) and advance care planning (ACP), to facilitate the alignment of care to the current and future needs and preferences of patients. Timely integration of palliative care into oncology care is important, to be able to discuss, fulfill and coordinate patients' care needs and preferences in a timely manner before a person loses capacity. The surprise question is often recommended as a tool to identify patients who may be in the final stage of life and thus might benefit from tailored palliative care. A multidisciplinary team approach combined with the use of standardised care pathways has been considered an essential part of such integration. Because oncology and palliative care are increasingly provided in the outpatient setting, various health care professionals, including hospital staff, general practitioners and district nurses, need to collaborate and exchange information. Nevertheless, hospital admissions in the last phase of life are frequent and a substantial number of patients die in the hospital, although most people prefer dying out of hospital.

In the Netherlands, palliative care is mostly provided by non-specialised healthcare professionals, who should have basic knowledge and skills in palliative care. When required, they can seek support from a palliative care specialist. In the Maasstad Hospital, a multidisciplinary group developed a digital standardised 'Palliative Care Pathway' (PCP) for patients with advanced, incurable cancer, to support healthcare professionals in the hospital with the timely initiation and provision of palliative care alongside tumour-specific care. The PCP is a structured electronic medical checklist to guide healthcare professionals, not specialized in palliative care,  in their provision of palliative care in daily practice.  Indications to start the PCP are: a negative answer to the surprise question (“Would you be surprised if this patient died within the next 12 months?”); deterioration of a patient’s performance status; a severe complication of medical treatment; the patient’s wish to stop all medical treatments; and/or a situation where no more anticancer treatment options are available. After opening the PCP, various prompts guide the physician to explore patients’ needs in all palliative care dimensions: physical, psychosocial and/or spiritual. Furthermore, the PCP facilitates the documentation of bad-news and ACP conversations, involvement of family and relatives and coordination of multidisciplinary care.
The overall aim of this thesis is to contribute to the quality and integration of palliative care and oncology care by evaluating hospital care at the end of life and the implementation of a digital standardised PCP.