Hospital-broad optimisation of advance care planning through improved communication

Advance care planning can help patients with a chronic, incurable disease to talk about their treatment wishes and end-of-life decisions in order to avoid inappropriate or unwanted care. Although patients and relatives indicate that they need these conversations, this is not always realised. An important finding is that patients expect their hospital physician to initiate these conversations because they themselves have insufficient knowledge of the seriousness of the illness and possible treatment options, and they often do not dare question the treatment strategy. Hospital physicians, however, indicate that they find it difficult to engage in these care planning discussions because they feel they lack the right communication skills. In this thesis project we aim to address in a well-founded way the barriers faced by healthcare providers, patients and in the structure/organisation of a tertiary teaching hospital in order to contribute to an improved context for advance care planning. We want to develop an innovative, interactive, online communication training that responds to the needs of doctors and patients and, at the same time, can overcome certain barriers. In a second part, we want to conduct a large survey with patients (and/or relatives) who were admitted to the hospital in the context of a condition with a negative impact on their prognosis. We want to find out whether they feel they received appropriate care or not and what they think the reasons for this are. Based on the results of this survey, in a third part we will formulate recommendations for interventions and/or further research.