Nederlands-Vlaams Tijdschrift voor Palliatieve Zorg

Introduction
Attention for the spiritual dimension is one of the focuses of palliative care. However, this dimension appears to be hardly integrated in care provision and is not always recognised by the caregiver. In the Netherlands, caregivers who are involved in care for people in the palliative phase can ask for advisory support from palliative consultation teams (PCT’s). For the moment it is unclear how care for the spiritual dimension of palliative care is warranted within the PCT’s. The question therefore arises how PCT consultation deals with the spiritual needs of the patient.
Method
To obtain insight in the policy of the consultation teams regarding the spiritual dimension, the coordinators of the consultation teams were asked to fill in a decision tree concerning: 1) the mission statement of the consultation teams about spiritual care, 2) the present expertise in this field and 3) plans for the development of this expertise.
Results
Members of PCT’s widely recognise the importance of attention for the spiritual dimension. A majority of the coordinators is of the opinion that their PCT lacks expertise in this field. The expertise that is present is organised in different ways and spiritual questions can end up with different caregivers. The chaplain is most frequently mentioned as the expert in the field of the spiritual dimension. There is a clear want for education in the field of the spiritual dimension and although there are various plans to realise this, many plans are in a premature stadium.
Discussion
On the basis of the results and in connection to the VIKC criteria for quality, four recommendations are formulated to warrant the spiritual dimension within the consultation services: 1) Attention for the spiritual dimension becomes explicitly part of the training ‘consultation competences’ and of the retraining of consultants, 2) The requirements for the quality of the educational content are formulated on the basis of a central directed inventory of visions on good spiritual care, 3) The chaplain has a central role in the development of expertise of consultants with regard to the spiritual dimension, and 4) The intended development of expertise is integrated with and geared to the expertise of the other disciplines within the consultation services.

Background
Dutch health care changes more and more into a demand driven system where patients and informal caregivers need tailor made information about possibilities in health care. Recent literature shows that good information for patients and their spouses in palliative care is lacking. This study tries to identify the need of information about palliative care amongst palliative patients, informal caregivers, future informal caregivers and the common public.
Materials en Methods
We used Q-methodology to identify different attitudes of the four mentioned groups toward information on palliative care.
Results
We found seven different attitudes amongst the four groups. Three attitudes were ‘basic attitudes’: 1) focus on dying, 2) focus of control on treatment and care and (3) focus on vitality during the palliative care. Information about physical en spiritual well-being during end-of-life care and dying weights most heavily for the first attitude. The need of information in the other two attitudes is about possibilities of care, treatment and health care institutions. There were significant differences in the attitudes: social context, kind of disease, stage of disease and if a person believes or has religion, spirituality or not.
The different attitudes amongst the four groups is characterized that patients and informal caregivers are more interested in information about physical en spiritual well-being during end-of-life care and dying. The becoming informal caregiver and the common public do not have a particular interest in one specific need of palliative care, but they are interested in (most of) ‘all’ subjects of palliative care. All groups wants to receive information from a general practitioner, medical specialist or psychologist.
Conclusions
The palliative patient or informal caregiver does not exist. Information about palliative care should be tailor made according to the specific needs that corresponds with the attitude of patients and their spouses.

Objective
To examine health professionals’ experiences of and attitudes towards the provision of chemotherapy to patients with end stage cancer.
Design
Purposive, qualitative design based on in-depth interviews.
Setting
Oncology departments at university hospitals and general hospitals in the Netherlands.
Participants
14 physicians and 13 nurses who cared for patients with metastatic cancer.
Results
Physicians and nurses reported trying to inform patients fully about their poor prognosis and treatment options. They would carefully consider the (side) effects of chemotherapy and sometimes doubted whether further treatment would contribute to patients’ quality of life. Both groups considered the patients’ well-being to be important, and physicians seemed inclined to try to preserve this by offering further chemotherapy, often followed by the patient. Nurses were more often inclined to express their doubts about further treatment, preferring to allow patients to make the best use of the time that is left. When confronted with a treatment dilemma and a patient’s wish for treatment, physicians preferred to make compromises, such as by “trying out one dose.” Discussing death or dying with patients while at the same time administering chemotherapy was considered contradictory as this could diminish the patients’ hope.
Conclusions
The trend to greater use of chemotherapy at the end of life could be explained by patients’ and physicians’ mutually reinforcing attitudes of “not giving up” and by physicians’ broad interpretation of patients’ quality of life, in which taking away patients’ hope by withholding treatment is considered harmful. To rebalance the ratio of quantity of life to quality of life, input from other health professionals, like nurses, may be necessary.

Background: Terminal care at home is receiving increased attention from the Dutch media, which is relevant for primary care providers.
Objectives: To explore the portrayal of terminal care at home in newspapers in the Netherlands in 2000 and in 2009.
Method: We performed a systematic analysis of documents retrieved form the LexisNexis Academic NL database. We compared data regarding the ‘point of reference’ (or ‘frame’) and the ‘moral judgments’ in articles appearing in the first six months of 2009 to the same period in 2000.
Results: In the year 2000, the framing of articles in regional newspapers appeared to be predominantly consumer-oriented (66%) and in national newspapers predominantly contextual (63%). The moral judgment in the regional articles was predominantly positive (66%), in the national newspapers predominantly negative (58%). In 2009, articles in regional and national newspapers were categorized mainly as consumer-oriented (73% and 55%, respectively), and new themes appeared, i.e. self care and medical topics. For moral judgment, again regional articles were mainly positive (76%) and national articles were mainly negative (39%) and neutral (31%).
Conclusion
Regarding the theme ‘terminal care at home’ as published in Dutch newspapers in 2009 as compared to 2000, the diversity of the framing was more prominent and over all moral judgments were more positive, particularly in regional newspapers. Health care providers should realize that the portrayal of palliative and terminal care at home may differ depending on the type of newspaper – regional or national.