Ietje Perfors

23 Introduction Cancer treatment decisions become more complex, due to the increasing number of treatment options. This enables a more personalised approach. 1 Incorporating personal preferences in treatment decisions requires shared decision making (SDM). SDM aims at establishing a treatment decision that optimally matches a patient’s personal preferences and expectations. 2 An effective SDM process consists of four steps: 1) awareness of choice, 2) explanation of treatment options, 3) time for deliberation, and 4) making an informed decision. 2 Unfortunately, in the present hospital oriented cancer care pathway, essential steps for successful SDM are usually insufficiently supported. First, patients are often unaware of their important role in choosing the ‘best fitting’ treatment. 3 Second, medical information, including treatment options, is often not understood by patients. 4 Third, time for deliberation is often limited, since the short in-hospital pathway between diagnosis and treatment choice generally does not facilitate reflection. This leaves little room to consider treatment options in the light of patient’s personal preferences and expectations. 3,5,6 General practitioners (GP) usually have longstanding relationships with their patients. Consequently, for many, the GP is the ‘trusted healthcare professional’, with longitudinal knowledge of their patients’ medical and personal history. 1,7 Hence, the GP is considered to be in the ideal position to guide the patient through the different steps of the SDM process. 1,6 Patients and GPs support this extended role for the GP in cancer treatment decision-making, e.g., through determining patient’s preferences, discussing treatment options and explaining medical information. 8-10 Positive effects of increased GP involvement after a cancer diagnosis have been described previously. Wallner et al. showed that patient’s experience of GP engagement, i.e., how informed the patient felt the GP was about the diagnosis, was associated with higher satisfaction of treatment decisions in cancer. 11 Wieldraaijer et al. showed that a consultation with the GP between diagnosis and start of treatment is beneficial for patient’s feelings 2