STUDY PROTOCOL Improving the quality of p n

Rotterdam, Rotterdam, the Netherlandsbecause hospital care is typically focused on prolonging life. Several studies have described the unmet needs of patients dying in hospitals, such as poor symptom con-trol and insufficient communication [1-6]. Gaps in end-of-life care have been identified, e.g. the lack of awareness of approaching death, and shortcomings in healthcare pro-fessionals ’ knowledge of and skills in palliative care [1-8]. To date research on end-of-life care in hospitals has been mainly descriptive, focusing on the characteristics of care, identifying problems and suggesting possibilities palliative care services in the hospital to enhance care-givers ’ attention for the transition of treatment goals; increase of palliative care knowledge among healthcare professionals; and improvement of prognostication, ad-vanced care planning and communication [9]. However, experimental studies on quality improvement interven-tions in end-of-life care in the hospital are scarce, partly due to methodological challenges in health services re-search in general and in the field of palliative care in par-ticular. Many results of studies on quality improvement interventions are thus affected by concerns about the validity and reliability of data, due to e.g. limitations of the design, selection bias, inaccurate measurements an