Ietje Perfors

139 these benefits and harms to occur in my personal situation? Incorporating the three questions model in decision making has been demonstrated to improve the quality of information about therapeutic options and to stimulate patients’ involvement in the treatment decision. 13 Follow-up care from primary care During the TOC, joint guidance by the GP and aHONwas offered to the patient. If a patient accepted HON guidance, the HON was notified and contacted the patient to plan a visit at the patient’s home. During this visit, the HON explained his/her role and made a personal support plan together with the patient. In this plan, the patient’s situation was mapped on four domains: living conditions, physical domain, psychosocial domain and existential domain. If one of the domains required active support the HON discussed the required actions with the patient and if necessary with the GP. The number, type, and duration of HON contacts was patient-driven, but it was recommended to have at least 3 contact moments, including one home visit during active treatment and two follow up contacts in the three months after completion of active treatment. To guide the content of all contact moments the Dutch Distress Thermometer 14 was used. This instrument includes items on five domains (i.e., practical, social, emotional, spiritual, physical), for which patients are asked to rank their level of distress. 14 The HON reported the condition of the patient and required actions to the GP. The hospital was also informed by the HON, in case supportive care was started based on the HON’s consultations (e.g., consultation of a psychologist, physiotherapist or dietician) or when treatment-specific questions arose. Intervention training All the participating HONs were registered nurses with a specialised training in oncology and hadmore than 2 years of clinical experience. In addition, they received a 4-h training from the GRIP study team. Participating GPs received basic information on the GRIP study by their GP cooperative organisations at the start of the study. Also, the GPs of intervention patients received the 6