Mariken Stegmann

is not (e.g. sterilisation) relevant for the current health problem.  Specialist letters  In total, 369 specialist letters were analysed. A structured format was used in all letters, but  these formats differed between departments and hospitals. The lengths of the letters  ranged from 1 to 4 pages, and the interval between date of consultation and date of sending  the letter ranged from 0 to 40 days (median 3 days, inter‐ quartile range 1–9 days). In a few  cases, treatment was started be‐ fore the GP had received written information about  diagnosis and treatment. The information provided in most specialist letters is summarised  in Box 2.  The following information was given in most specialist letters:   Date of consultation or hospitalisation   Relevant past medical history, including, if applicable, current diagnosis and recent  treatment    History paragraph (e.g. which symptoms does the patient have)   Physical examination, often restricted to abnormal findings   Results from additional diagnostic tests (e.g. blood results)   (Preliminary) diagnosis   Policy (e.g. additional diagnostic test, new treatment, next visit)   Meta‐communication (what does the patient know  Box 2 . Common topics in Specialists’ Letters  All these letters contained information about actual treatment. Often this information was  comprehensive and provided details about the exact type of surgery, chemotherapy or  radiotherapy, together with the dose, frequency and period of treatment. However, an  explicit statement about whether the treatment was given with curative or palliative intent  was rare. Treatment alternatives and patient preferences were also seldom written down. If  they were mentioned, it was mostly because an alternative had been chosen for medical  reasons, such as for severe comorbidity or certain tumour characteristics (e.g. a specific  mutation; see Q2). In the interviews, GPs also mentioned a lack of specific information  about the curative or palliative intent of a treatment.  Q2: Wait for mutation analysis. To choose either a TKI‐inhibitor or chemotherapy  with cisplatin‐pemetrexed  Specialist letter ‐ policy (Large non‐academic hospital, lung cancer, Doc19)  Plain language: Wait for a specific genetic test, based on which we will choose for  either immunotherapy or chemotherapy.  All specialist letters contained details of the patient’s history, but often provided other  information too; in some cases, no history was provided at all. A typical example (e.g. Q3)  included information about what was discussed with the patient during the consultation.  Q3: History: Patient visited our outpatient clinic together with four children. Results  discussed.  Specialist letter ‐ history. (Academic hospital, lung cancer, Doc49)  Additional diagnostic tests were reported in detail. In most cases, the report of the  6 71 Qualitative mixed-methods analysis of correspondence