Mariken Stegmann

this role should be formalised. 15 In some GP practices, the practice nurse may provide some of the care for older patients, and more rarely, to oncological patients. This role has not been described in the literature. Collaboration between primary and secondary care To establish effective collaboration between primary and secondary care, it is essential that important information is shared. GPs refer patients to the hospital with a referral letter, and after consultation, medical specialists provide the GP with diagnostic and treatment information in a specialist letter. The results in Chapters 6 and 7 show that the information desired by each party is often not shared. In both instances, there is a need to write the letter to the needs of the receiver, and both medical specialists and GPs preferred to receive telephone calls and letters (Chapter 6). Although this has been mentioned in other research, 16,17 phone calls can be difficult to realise because the receiver is not always available when a call needs to be made. However, the growth in mobile phones and apps raise the possibility of new opportunities. Hospital call centres, for example, often have access to the mobile phone numbers of specialists and occasionally of GPs. Some medical specialists also include their personal phone numbers in specialist letters or communicate with GPs via new chat platforms. The shared decision ‐ making method SDM should only occur when all key stakeholders are involved and if all essential steps are taken. These steps are described in more detail in the introduction, but they are summarised in Box 1. Hereafter, I discuss what new knowledge this thesis adds to each step. Procedure for Shared Decision ‐ making 1) Announcement of decision 2) Explanation of options 3) Discussion of patient preference 4) Shared decision is made Box 1. Steps of the shared decision ‐ making procedure Steps 1 and 2 of SDM: Announcement of decision and explanation of options In Chapter 7 we showed that the chosen treatment is described in most specialist letters, but without mentioning other treatment options. This is consistent with recent literature showing that treatment options are often not discussed with patients. 4,18,19 In the OPTion RCT (Chapter 4), we did not explicitly study this topic, but both patients and GPs often reported that there was only one treatment option. Also, in OPTion2 (Chapter 5; n = 29), several treatment options were described in the patient record for only six patients, and the considerations for the treatment choice were only described explicitly for two cases. However, our findings in Chapter 7 indicated that patients, GPs, and medical specialists agree that information about the various treatment options is relevant in the specialist letter. This supports the position paper of the NHG, which states that GPs should be able to discuss available treatment options with their patient. In the NFK GP/nurse survey, 67% of respondents wanted the GP to explain the importance of the patient’s opinion in decisions and 69% wanted them to check that information about diagnosis and treatment options had been understood. 14 To promote discussion of treatment options, the “Ask 3 Questions” campaign has been launched worldwide (Dutch: 3 goede vragen ), in which patients are encouraged to ask health 8 109 Summary and General discussion