Mariken Stegmann

Role of the GP in the Dutch healthcare system  As in several other Western countries, all patients in the Netherlands are registered with a  GP. Dutch GPs provide near and accessible primary health care and offer a 24/7 care service.  They often have a long and invested relationship with their patients, in particular with older  patients. The GP also acts as a care coordinator, being responsible for managing all their  patients’ medical data and for liaising with specialists from different services.  Because of this central position in the healthcare system, Dutch GPs also play an important  role for patients with cancer throughout the cancer trajectory. After their role in screening  and early diagnosis, 24  most GPs have contact with their patient shortly after diagnosis.  Therefore they are sometimes mentioned as the best positioned health care provider for a  time out consultation during the deliberation phase between the third and fourth step of the  shared decision making process in the hospital. 25  Because of their longstanding relationship  with the patient, GPs are often optimally informed about the patient’s medical and  psychosocial history, personal preferences and individual coping and communication style.  In this way they can help patients to weigh the pros and cons of a specific treatment. 25,26 However, literature about the feasibility and effects of these consultations is scarce as is  information about actual use of these consultations.  After diagnosis, GPs aim to provide continuity of care during cancer treatment. Patients with  cancer who are treated with a curative intent have more frequent contact with their GP  compared to patients without cancer in the first year after diagnosis. 27,28  The GP is the first  contact for new physical problems, but can also provide emotional support for patients and  family members. 24,26  Similar studies are not available for patients with cancer treated with a  palliative intent, but it is likely that those patients will also have frequent contact with their  GP during treatment. Due to parallel contacts of patients with both the GP and the medical  specialist, communication between primary and secondary care is important.   Communication between medical specialist and GP  Communication between GPs and medical specialists often happens through written  digitalised correspondence. A special guideline for both GPs and medical specialists, provides  suggestions for adequate communication. 29  Unfortunately, studies have shown that both  GPs and medical specialists are not very satisfied about their mutual communication. 30,31  It is  unknown which information is shared or not shared and which information is deemed  essential by the different healthcare providers. However, according to both patients, GPs  and medical specialists, inadequate communication can lead to discontinuity and suboptimal  quality of care. 32–34  This makes mutual communication and collaboration of healthcare  providers an important opportunity to improve healthcare for patients with cancer.   Thesis outline  The objective of this thesis is to analyse the communication around cancer patients and the  role of the general practitioner (GP) in this process,. We studied two types of  communication: GP‐patient and GP‐medical specialist. Concerning the first type, we aimed  to analyse the added value of a conversation about treatment goals with the GP in the  process of shared decision making for patients with cancer. The second aim was to analyse  the communication between GPs and medical specialists about patients with cancer.   12 Chapter 1