Mariken Stegmann

population with a strong wish for treatment.  Our study suggests that patients’ goals become less stable when they enter the late phase of  their disease. In practice, it is a challenge for health care providers to determine when  patients have entered this phase. The surprise question (“Would I be surprised if this patient  died in the next year?”) has been shown to be a simple and effective tool for identifying  patients with cancer who have a greatly increased 1‐year mortality risk. 15  Recently, it was  suggested that a double surprise question, adding “Would it surprise me if this patient is still  alive after 12 months?” had even better predictive values. 16  Our research also showed that  non‐disease‐related life events may be a trigger for change, though it remains a challenge to  identify such patients who are about to change their goals and may want to adjust their  treatment accordingly. This is in line with the widely supported suggestion that health care  professionals in the field of palliative care should discuss not only physical issues but also  psychological, social, and existential issues. 17 Finally, the GP was asked to perform the OPT conversations in the current study. This was a  deliberate choice based on the often longstanding relationship between GPs and older  patients in the Netherlands. 10,18,19  In a recent survey, more than two‐thirds of responding  cancer patients indicated a need to discuss their treatment decision with the GP  20 . During  this conversation, the GP must explain information, check understanding, and discuss  priorities. 20  However, it is important that this supplements, rather than replaces, the  discussions that patients have about goals and preferences with medical specialists and/or  specialist nurses. 5 Conclusion  We showed that the treatment goals of older patients with non‐curable cancer can change  over time, and that these changes may be related to the primary disease or to other life  events. Future research may benefit from analysing the audio recordings of consultations or  from interviewing patients about their goals and the reasons for changes. In the meantime,  however, health care providers should endeavour to discuss goals regularly with their  patients. This enables the health care provider to more directly assist the patient in making  choices, by linking the discussed goals to the different treatment options. This should  certainly occur when there is a change in the disease, but we contend that it may be more  prudent to perform this as part of a regular and more comprehensive multidomain  assessment. Correctly and regularly identifying patient goals, as well as communicating them  with other health care providers, can help ensure that therapy remains appropriate and  evolves with the needs of patients.  Additional information  Funding  This study was supported by a grant from the Dutch Cancer Society Fund (KWF  Kankerbestrijding) (ref: RUG 2014‐7273). The sponsor has no role in the study design,  collection, analysis, interpretation of data, the writing of the report, or in the decision to  submit the article for publication.  Conflicts of interest  The authors have declared no competing interests.  62 Chapter 5