Ietje Perfors

126 Chapter 5 addition, we cannot exclude that the GP provided contradicting information on the treatment decision. Last, during the development of the intervention, we involved the NFK and the participating general practitioners, but hospital care professionals had less input in the development of the intervention, which may have hampered implementation of the TOC. The clinical implications of this study are not easy to define. Our study demonstrates that in the present cancer care continuum it is logistically difficult to adequately plan a TOC in primary care between diagnosis and treatment. This seems mainly due to the urgency to start treatment after a cancer diagnosis. Besides hampering TOC implementation, this perceived urgency may impede the potential to reflect on the optimal therapy choice by obstructing the deliberation process. This study also showed that the majority of patients was motivated to consult the GP in preparation for the final treatment decision with the specialist. Hence, to evaluate the effects of a TOC, the planning of the TOC needs to be optimised. To ensure that the TOC is effectively incorporated in the decision process, the hospital team should probably be involved in the TOC planning. In conclusion, planning a TOC in primary care between diagnosis and treatment decision for cancer patients treated with curative intent was challenging due to the short time between diagnosis and treatment choice. Although patients’ acceptance was high, the majority of TOCs in our study was planned after the treatment decision had already been made. Effects of a timely TOC could therefore not be established. Non-timely TOC decreased perceived SDM. Planning of the TOC should be optimised, and future research should explore if an adequately timed TOC results in improved SDM for cancer patients.