Mariken Stegmann

Current study  In this study, we followed‐up on the patients included in the intervention group of the  OPTion RCT. We repeated the OPT‐facilitated GP conversations at 4 weeks, 3 months, and 6  months after baseline and noted the OPT scores. All patients did the follow‐up conversations  with the same GP as the baseline conversation. Whether former OPT‐scores were  mentioned as reference was decided by the GP. Text entries made by health care providers  were examined in the electronic patient records of hospitals and GP practices from baseline  to 6 months. This included both documentation about routine visits and about OPT‐ conversations. In the Netherlands, GP function as care coordinators and gatekeepers to  specialist hospital care. Between hospital visits, most patients also have contact with their  GP. Figure 1. Example of the Outcome Prioritisation (OPT) Tool. Note that in this example of the OPT, the  most important goal for this patient was to maintain independence.  Data analysis  We descriptively analysed the OPT scores and their changes over time. In the patient  records, we checked if a patient had died, and if so, extracted the date of death. Patients  were categorised by their disease phase (early/late) and goal pattern (change/stable). We  defined patients as being in the late phase of disease if they died within 1 year of their last  follow‐up conversation. We defined goals as having changed when the most important  treatment goal changed or when at least one value changed by ≥20 points (scale 0–100  points) at two consecutive OPT conversations. Thereafter, we analysed the text entries from  patient records in a qualitative hypothesis‐generating manner. Two researchers (MES and  DB) independently analysed all text entries using an open coding system, with codes  grouped into themes in an axial way. The two researchers discussed and compared their  findings until consensus was reached, and a third researcher (AJB) was consulted if  disagreement persisted. Representative quotations ( Q ) are presented and identified by a  patient number in the results. Each quotation is accompanied by the corresponding OPT  scores , which are displayed as the four scores for extending life, maintaining independence,  56 Chapter 5