Ietje Perfors

124 Chapter 5 Discussion This study aimed to evaluate the effects of a TOC with a GP shortly after a cancer diagnosis for patients scheduled to be treated with curative intent, on perceived SDM, received information and perceived self-efficacy. Although the TOC was well accepted by patients (80.5%did make an appointment with the GP after diagnosis), only one fifth was adequately planned, i.e., before a treatment decision was made in the treating hospital. Therefore, we could not adequately evaluate if there is a benefit from the TOC on the SDM process. A GP consultation post treatment decision resulted in lower SDM. It appeared to be challenging to plan a TOC preceding the treatment decision. This can be explained by the fact that current time interval between diagnosis and therapy decision is (too) short. For 22% of the patients, who weremainly patients with breast cancer or melanoma, the treatment decision was made on the day of the diagnosis. For half of all patients, a decision was made within seven days. The assumption that a short time to make a decision hampers TOC planning according to protocol is supported by the observation that the time between diagnosis to therapy decision was short (median 5 days) for those patients who had the TOC after treatment decision. Also, participating clinicians report that the current cancer care pathway is focused on rapid diagnostics 27 and early start of treatment. Delayed TOC planning in this study may also be partly related to the time required for patients to consider study participation. Finally, delayed TOC planning may also be related to the pragmatic design of our study: instead of the research team or the hospital scheduling the TOC for the patient, we decided to leave this responsibility to the patient, thus reflecting current daily care practice. In the short and stressful period between diagnosis and therapy choice, scheduling a TOC may not have been feasible for the majority of patients. Our results show that perceived SDM was lower if a TOC was planned after treatment decision. The most likely explanation is that patients perceive SDM more negatively if they are informed and coached on the added value and possibility of SDM, after the possibility to actually apply SDMhas already passed.