Mariken Stegmann

Abstract  Purpose. To investigate treatment goals of older patients with non‐curable cancer, whether  those goals changed over time, and if so, what triggered those changes.  Methods. We performed a descriptive and qualitative analysis, using the Outcome  Prioritisation Tool (OPT) to assess patient goals across four conversations with general  practitioners (GPs) over 6 months. Text entries from electronic patient records (hospital and  general practice) were then analysed qualitatively for this period.  Results. Of the 29 included patients, 10 (34%) rated extending life and 9 (31%) rated  maintaining independence as their most important goals. Patients in the last year before  death (late phase) prioritised extending life less often (3 patients; 21%) than those in the  early phase (7 patients; 47%). Goals changed for 16 patients during follow‐up (12 in the late  phase). Qualitative analysis revealed three themes that explained the baseline OPT scores  (prioritising a specific goal, rating a goal as unimportant, and treatment choices related to  goals) Another three themes related to changes in OPT scores (symptoms, disease course,  and life events) and stability of OPT scores (stable situation, disease‐unrelated motivation,  and stability despite symptoms).  Conclusion. Patients most often prioritised extending life as the most important goal.  However, priorities differed in the late phase of disease, leading to changed goals. Triggers  for change related to both the disease (e.g., symptoms and course) and to other life events.  We therefore recommend that goals should be discussed repeatedly, especially near the end  of life.  Trial registration: Based on the OPTion study (NTR5419)  54 Chapter 5