Mariken Stegmann

Coding  First, the files of three departments in an academic hospital were analysed, and saturation  was reached for lung, breast and colorectal cancer after 19, 15 and 11 files respectively.  Thereafter, we analysed the files of two non‐academic hospitals until saturation was  reached. The final code list contained 70 codes in 13 themes (Supporting Information Table  S1). Agreement between the coding researchers was 90% on average. No additional codes  were identified from interviewing the healthcare professionals.  Referral letters from GPs  In total, 50 referral letters were analysed; 96% of these were written using ZorgDomein,  the others were written without a program. The referral letters were one to two pages  long, although a medication list was sometimes attached on a separate page. Box 1  contains a summary of the information provided in most referral letters.  The following information was given in most referral letters   Reason of referral/specific request   Past medical history and current use of medication    History, family history and intoxications   Physical examination   Additional diagnostic information  Box 1. Common topics in Referral Letters  In general, the referral letters tended to contain relevant information for the oncology  healthcare provider mixed with information less relevant for the current problem. This was  most notable in the past medical history, where major and minor health problems were  often detailed in one list without prioritisation (Q1), and sometimes without a  chronological order. To a lesser extent, the same held true for the medication list and  history of the presenting complaint. In the latter case, information about different aspects  of the patient’s history was mixed, often with information about the physical examination.  This mixed presentation of data was also mentioned in the interviews. An example of this  problem can be seen in Q1.  Q1:  ‐ 16‐07‐2010 Proximal phalanx left 5th digit fracture  ‐ 30‐11‐2009  Osteoporosis  ‐ 02‐07‐2009 Diabetes Mellitus type 2  ‐ 02‐03‐2008 Rib # right, liver contusion (dd rupture) after fall  ‐ 01‐01‐2005 Polyarthralgia based on arthrosis  ‐ 01‐01‐2000 Morton’s neuroma  ‐ 01‐01‐1999 Mamma reduction  ‐ 01‐01‐1987 Rotator cuff syndrome  ‐ 01‐01‐1963 Adenomyosis of gallbladder, because of which   cholecystectomy  ‐ 01‐01‐1980 Sterilisation  ‐ 01‐01‐1973 Appendectomy  ‐ 15‐10‐2013 Coughing  Referral letter – past medical history. (Lung cancer, doc90). This quotation shows a  non‐chronological order and a mix of information that is (e.g. diabetes mellitus) and  70 Chapter 6