Ietje Perfors

91 discussion with the patient as described below and an instruction to consult the HON after the Time Out consultation. In addition, the GPwill be explained to not follow this structure when consulting cancer patients randomised to the control arm of the GRIP study in order to reduce contamination. The Time Out consultation aims to facilitate continuity of primary care, to support the patient in a time of uncertainty, and to explore personal perspectives and preferences of the patients which may affect treatment choice to support shared decision making in secondary care. During this consultation the GP addresses a number of issues preparing for active participation of the patient: reflection on the diagnosis and prognosis, psychosocial consequences, awareness that a choice of treatment exists and the recommendation to use the ‘three questions’ model in the consultation with the specialist on treatment decision. 18 These three questions are: What are my options? What are the possible benefits and harms of those options? How likely are the benefits and harms of each option to occur in the patients’ specific information? 18 Incorporating the three questions model in decision making has been demonstrated to improve the quality of information about therapeutic options and facilitate patient involvement. 2) Follow-up care during and after active treatment After the Time Out consultation and the final treatment decision in secondary care, the Homecare Oncology Nurse (HON) will be contacted by the GP to schedule a visit at the patients’ home. During this visit the HON explains his/ her role and makes a personal support plan together with the patient. In this plan, the patient’s situation is mapped on four domains: living conditions, physical, psychosocial and existential domain. If one of the domains requires active support, the HON discusses the required actions with the patient and with the GP. The number, type and duration of contact moments with the HON is patient driven, with a minimum number of two contacts during the primary treatment phase, including the first home visit, and two contacts within 3 months after active treatment has ended. The content of contacts is based 4