Ietje Perfors

138 Chapter 6 Usual care Usual care after a cancer diagnosis takes place in the hospital. It is to a great extent protocolised and differs depending on cancer type, hospital protocol, patient and caretaker characteristics and patients’ preferences. Hospital based cancer care consists of different phases: diagnostic workup, choice of treatment, delivery of treatment and follow-up care. Treatment options are discussed in a multidisciplinary team and in general follow national guidelines. Cancer care in the hospital is usually delivered bymedical doctors specialised in oncology and oncology nurses. Primary care is not involved in cancer treatment on a structural basis. The GP receives information by phone or by mail after the multidisciplinary team in the hospital reached consensus on the treatment. Hereafter, some GPs may contact the patient proactively, but in most cases they take a more reactive role and participate during cancer treatment on patient’s request. Supporting primary care services (e.g., psychologist, physiotherapist, dietician, social worker) are only involved if considered necessary. HONs are only incidentally involved during curative cancer treatment. Intervention In addition to usual care, patients in the intervention group were offered structured guidance from primary care, which consisted of two components. Time Out Consultation (TOC) Intervention patients were advised tomake a TOC appointment with their GP. The TOC is a 20-minute consultation before the final treatment decision in the hospital. The TOC aims to initiate primary care involvement after diagnosis and prepare patients for SDM in the hospital. For this consultation, the GP was instructed to give psychosocial guidance, create awareness that a choice of treatment exists and to instruct the patient to use the three questions model (Shepherd et al. 2011) during the final discussion on the treatment options in the hospital. 13 These three questions are: What are my options? What are the possible benefits and harms of those options? How likely are