Table 2 Description of themes and quotes

A The training

B Identification of the palliative patient

 1. “(…) regarding patients with CHF or COPD it becomes a hell of a job. And particularly when it concerns progress in time, that is also difficult. But when it concerns a patient with cancer, you know by and large (…) what is going to happen, and thus how to develop a plan.” (consultant)

C Communication with the patient

 2. “But when you consider to start discussing end of life aspects, then I realize that such a message will come across the patient as quite a burden. […] (GP)

 3. “I tended to communicate concealed and now I am more straight. (GP)

 4. “It is possible to prepare patients, and I am better prepared myself too.” (GP)

 5. “More than before, I keep an eye on them (…), people of whom you realize that they will not cure anymore, with whom it sooner or later will go wrong, like patients with COPD, CHF, that kind of people.” (GP)

 6. “It is not just arranging more care, but also assessing what goes wrong or can go wrong and how can I anticipate on that (…) which can result in more care provision, but also in medication, or checking things.” (GP)

D Proactive care planning with the problems square

 7. “I mean, as a GP I already did it that way but not as structured as with the problems square. And now it is easy to check did I consider all aspects, as it is sometimes mixed up.” (GP)

 8. “I really liked the idea […] to consider prospectively what might occur […] in the several segments.”(GP)

 9. “Doing it completely like stated in the protocol asks a lot of time, while many aspects will be addressed during the conversation anyhow.” (GP)

 10. “With this kind of things, and that probably also counts for the problems square and the RADPAC, there will be a bigger chance that I use it when it is integrated as a protocol in the electronic medical record.”(GP)

E Consultant – GP interaction

 -Experiences of the consultant

 11. “(…), as a consultant, you receive all kind of questions and honestly: I don’t know everything from neurology to paediatrics and all other specialties. So, also as a consultant you need dare to say: ‘I cannot answer this question, I will consult someone else myself (…).” (consultant)

 12. “No, in fact nothing needed to be solved acutely. You could frankly take a helicopter view (…).” (consultant)

 -The role of the GP

 13. “The advantage is, (…) at the moment the GP fills in the problems square and he does it in a conscientious manner, than a lot of the potential future problems are already considered, just by filling in the form…” (consultant)

 14. “The GP has a clear picture of the patient and probably knows him quite well. I, on the contrary, only know what has been filled in the problems square.” (consultant)

 -Interaction between consultant and GP

 15. “That is my trick, a bit as when you sit down to table (…) and give people room to talk, than you gain a lot more than when you just tick a check box.” (consultant)

 -Follow up

 16. “And at the same time, I would be curious whether the proactive suggestions you had provided (…) had landed and thus if the advice had an added value for the GP and probably for the palliative care for that specific patient…” (consultant)