Mariken Stegmann

The objective of this thesis is to analyse the communication between patients with cancer, general practitioners (GPs) and medical specialists. This analysis is based on two large studies, the OPTion-study and the PION-study. In the OPTion-study older patients with non-curable cancer had an extra conversation with their GP before their treatment decision. During this conversation they used the Outcome Prioritisation Tool (OPT), which allowed the patient to indicate what the main goal of the treatment should be - for example maintaining independence or extending life. Both patients with and without OPT-conversation were found to have very high confidence in their involvement in treatment decisions. However, patients in the OPT-group were less anxious than patients who received care as usual. Both GPs and patients were positive about the OPT conversation. A follow-up study showed that some patients changed their goals during their illness. These changes could be related to progression of the disease as well as to other life or environmental events. The PION-study focused on the communication between GPs and specialists. First, patient records were used to explore which information doctors exchange. Subsequently, panels of GPs, specialists and patients assessed which information the referral letter and the specialist letter should contain. A striking conclusion is that doctors hardly communicate about the various treatment options. Most letters only refer to the chosen treatment and not to other treatment options. The results of the two studies provide recommendations that should lead to better, more person-centered care for patients with cancer. www.huisartsgeneeskunde-umcg.nl/marikenpromoveert Communication in oncology Mariken Stegmann