Improving aspects of palliative care for children

This thesis is about improving aspects of palliative care for children, and covers three different areas of quality of care. First of all, palliative care should be anticipating. To be able to deliver this anticipating care, caregivers should know what to expect. The first two chapters of the thesis provide insight in the symptoms children have in the palliative phase of different types of cancer. These chapters focus specifically on the management on pain. The second part of the thesis describes a pediatric palliative case management team. Chapter four provides information on which patients receive support of the team, the intensity and duration of support. Chapter five describes the timing of support, the topics discussed with the team and the consultation of the different disciplines within the team. The sixth chapter, which comprises the third part of the thesis, provides insight in the compliance to the national clinical guideline “pediatric palliative care”. The chapter describes the process of quality indicator selection, the development of a multifaceted educational program and the pre- and post-intervention testing of the compliance. Overall, this thesis provides insight in how the quality of pediatric palliative care could be improved and gives suggestions for future research.