Mariken Stegmann
Setting and study design As in several other Western countries, Dutch GPs have a long relationship with their patients and they provide 24/7 primary care service. The GP also acts as a care coordinator, being responsible for managing all of their patients’ medical data and for liaising with specialists from different services. This study is designed according to the SPIRIT guidelines 18 and planned to be a two‐armed parallel group pragmatic randomised trial. 19 We will study the effects of GPs eliciting preferred treatment goals on patient self‐efcacy, among older patients with cancer in a palliative setting, in comparison to care as usual. The primary endpoint is the perceived self‐ efcacy directly after consultation with an oncologist during which the choice for a specic treatment has been made (Fig. 1). Participants Recruitment Eligible patients will be recruited by oncologists from eight locations of ve hospitals (one academic and four non‐academic) in the north of the Netherlands when a new treatment decision is to be made (e.g. at the moment of diagnosis). The oncologist will then check the inclusion and exclusion criteria, and if suitable, will provide interested patients with written information about the study and ask for permission to send their contact details to the researchers. Inclusion and exclusion criteria Participants will be required to be aged 70 years or older, have non‐curable cancer, and be in a position requiring them to make a new treatment decision. We will exclude patients if they have a life expectancy of less than three months, have a severe psychiatric disorder; are unable to ll out questionnaires; or have a hematologic malignancy (because the course of these diseases differ from solid tumours 20 ). Patients formerly treated curatively will not be excluded, neither will patients with other comorbidities. Randomisation After receiving informed consent, patients will be consecutively allocated to the intervention or care as usual groups. The 1:1 allocation sequence will be produced by a web‐based randomisation application using random permuted blocks with randomly varying block sizes stratied by hospital. Allocations will then be kept in a locked le on a computer system, inaccessible to the recruiting oncologists and the researchers. Intervention Care in intervention group When patients are randomised to the intervention group, they will be asked to arrange an appointment with their GP before the next scheduled consultation with their oncologist. During this appointment with the GP the diagnosis of cancer in a palliative setting, and its consequences will be discussed. Using a specifically designed “Outcome Prioritisation Tool” (OPT), also called the “preference slider,” preferred treatment goals will then be explored. 9,21 This OPT is a card with four visual analogue scales, each representing a generic treatment goal (Fig. 2): life extension, preserving independence, reducing pain, and reducing 2 21 Protocol for the OPTion study
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