Mariken Stegmann

Ethics approval  The trial was assessed by the Medical Ethics Committee of the University Medial Centre  Groningen (ref: 2015/275)  Consent to participate  All participants provided informed consent  Authors' contributions  All authors contributed to the study conception and design. Material preparation, data  collection and analysis were performed by MES and DB. The first draft of the manuscript was  written by MES, DB and AJB and all authors commented on previous versions of the  manuscript. All authors read and approved the final manuscript.  Acknowledgments  The authors would like to thank the participating hospitals  (Universitair Medisch Centrum  Groningen, Wilhelmina Ziekenhuis Assen, Ommelander ZorgGroep, Trant Zorggroep and  Medisch Centrum Leeuwarden) and all participating GPs for their efforts. They would like to  thank Lisa Louer, Pim Brandenbarg and Loes Overeem for their help with data collection.  Finally, they thank Robert Sykes for providing editorial services  (www.doctored.org.uk) 5 63 Treatment goals and their changes over time