Patient-physician communication at the end of life: a European perspective The research presented in this thesis was conducted within the EMGO Institute for Health and Care Research, Department of Public and Occupational Health of the VU University Medical Center, Amsterdam, the Netherlands. Financial support for the research included in this thesis: Marie Curie PhD Fellowship Funding for Natalie Evans’ Marie Curie PhD Fellowship came via EUROIMPACT funded by the European Union Seventh Framework Programme (FP7/2007–2013, under grant agreement nu [264697]). EURO SENTIMELC Funding for the EURO SENTIMELC came from the Institute for the Promotion of Innovation by Science and Technology in Flanders as a Strategic Basic Research project (SBO) (contract SBO IWT 050158) (2006– 2010), as part of the ‘Monitoring Quality of End-of-Life Care (MELC) Study’. Funding also came from the Italian Ministry of Health through the ‘Evaluation, testing and implementation of supportive care, care interventions, integrated programs and improving the quality of care for cancer patients’ program ‘Integrated Oncology Project no6, years 2008–2011’, from the annual budgets of the Autonomous Community of Castilla y León and Comunitat Valenciana. LASA Funding for the Longitudinal Ageing Study Amsterdam came from the Ministry of Health, Welfare and Sports, Directorate of Long Term Care. Qualitative interview data Funding for the primary studies was obtained from the following sources: The Belgian Science Policy and VUB (Belgium); The Centre for Development of Palliative Care Amsterdam, and the Dutch Ministry of Health, Welfare and Sports (The Netherlands); and Dimbleby Cancer Care (UK). ISBN/EAN 9789461087669 Cover design: Layout: Printing: Christopher Pell Natalie Evans Gildeprint Drukkerijen, Enschede Financial support for the printing of this thesis was provided by the VU University, the EMGO+ Institute and the Vrije Universiteit Brussel. © 2014, Natalie Evans, Amsterdam, the Netherlands No part of this thesis may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photography, recording or any information or retrieval system, without permission of the copyright owner. VRIJE UNIVERSITEIT Patient-physician communication at the end of life: a European perspective ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. F.A. van der Duyn Schouten, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de Faculteit der Geneeskunde op maandag 13 oktober 2014 om 13.45 uur in de aula van de universiteit, De Boelelaan 1105 door Natalie Claire Evans geboren te Londen, Verenigd Koninkrijk promotoren: copromotor: prof.dr. B.D. Onwuteaka-Philipsen prof.dr. L.H.J. Deliens dr. H.R.W. Pasman