Communication in oncology: positioning the general practitioner in shared decision making for patients with cancer

Abstract

Chapter 1 General IntroductionChapter 2 Study protocol for the OPTion randomised controlled trial on the effect of prioritising treatment goals among older patients with cancer in a palliative setting Chapter 3 Using the Outcome Prioritisation Tool (OPT) to assess the preferences of older patients in clinical decision-making: a review Chapter 4 Prioritisation of treatment goals among older patients with noncurable cancer: the OPTion randomised controlled trial in Dutch primary care Chapter 5 Treatment goals and their changes over time of older patients with non-curable cancer Chapter 6 Correspondence between primary and secondary care about patients with cancer: A qualitative mixed-methods analysis Chapter 7 Correspondence between primary and secondary care about patients with cancer: a Delphi consensus study Chapter 8 Summary and General discussion Appendices Epidemiology of frequent types of cancer and cancer symptoms Research Institute SHARE Nederlandse Samenvatting Dankwoord Publicatielijst Curriculum VitaeChapter 1 General introduction 1 9 General introduction 10 Chapter 1 11 General introduction Role of the GP in the Dutch healthcare systemAs in several other Western countries, all patients in the Netherlands are registered with a GP. Dutch GPs provide near and accessible primary health care and offer a 24/7 care service. They often have a long and invested relationship with their patients, in particular with older patients. The GP also acts as a care coordinator, being responsible for managing all their patients' medical data and for liaising with specialists from different services. Because of this central position in the healthcare system, Dutch GPs also play an important role for patients with cancer throughout the cancer trajectory. After their role in screening and early diagnosis, 24 most GPs have contact with their patient shortly after diagnosis. Therefore they are sometimes mentioned as the best positioned health care provider for a time out consultation during the deliberation phase between the third and fourth step of the shared decision making process in the hospital. 25 Because of their longstanding relationship with the patient, GPs are often optimally informed about the patient's medical and psychosocial history, personal preferences and individual coping and communication style. In this way they can help patients to weigh the pros and cons of a specific treatment. 25,26 However, literature about the feasibility and effects of these consultations is scarce as is information about actual use of these consultations. After diagnosis, GPs aim to provide continuity of care during cancer treatment. Patients with cancer who are treated with a curative intent have more frequent contact with their GP compared to patients without cancer in the first year after diagnosis. 27,28 The GP is the first contact for new physical problems, but can also provide emotional support for patients and family members. 24,26 Similar studies are not available for patients with cancer treated with a palliative inten...