Mariken Stegmann

Traditionally, cancer  management is provided by oncologists and in the Netherlands most  patients also visit their GP during diagnosis and treatment. 13,14  In countries where the GP  functions as a gatekeeper to secondary care, older patients often have a long‐term  relationship with their GP and consider them a trusted healthcare adviser. 15,16  This makes  the GP well placed to support patients in exploring generic treatment goals and in  empowering them for shared decision making with an oncologist.  The authors designed an intervention in which GPs used the OPT to facilitate a conversation  with older patients in the period between a diagnosis of non‐ curable cancer and treatment  decisions, 17  focusing on identifying the patients’ generic treatment goals. The primary aim of  this study was to analyse the effects of these OPT‐facilitated conversations on patient  empowerment.  Method  This randomised controlled trial was registered in the Dutch trial register (ref: NTR5419), and  the study design is published in detail elsewhere. 17 Participants  Participants were recruited from nine locations in six hospitals (one academic) between  November 2015 and January 2019. Patients were eligible if they were aged ≥60 years, had  cancer that had no curative treatment options, and had to make a treatment decision with  an oncologist. Patients were excluded if they had a life expectancy of <3 months or were  unable to complete the questionnaires. Patients with haematological cancers were also  excluded because they are known to have a different disease course. 18 After providing informed consent, patients were randomised to an intervention group (OPT‐ facilitated conversation) or control group (care as usual) on a one‐to‐one basis, stratified by  hospital. Allocation was determined by a web‐based application (ALEA) that used random  permuted blocks with randomly varying block sizes.  Intervention  The intervention consisted of a conversation with the GP during which treatment goals were  explored with the aid of the OPT. 11,12  The OPT is a decision aid with four visual analogue  scales, each representing a generic treatment goal: extending life, maintaining  independence, reducing pain, and reducing other symptoms (Figure 1). The tool was  developed in the US and designed to discuss, with patients, which (treatment) goal was most  important to them. 11,12  GPs were contacted via telephone by the research team. After their  consent, the OPT was sent to them with a short user manual that also contained a hyperlink  with a video example of an OPT‐facilitated conversation. GPs invited patients to value and  rank the different goals according to the trade‐off principle that the goals cannot be equally  important. Patients received no instructions about what to tell their oncologist. The control  group received care as usual and could consult their GP at their own discretion. Blinding was  not possible owing to the nature of the intervention. Immediately after their follow‐up  consultations with oncologists, during which the treatment decision was made, patients  from both groups completed questionnaires (Figure 2). Oncologists did not receive any  training as they played no role in the intervention.  42 Chapter 4