Mariken Stegmann

Rarely used codes  Almost no remarks were found about advance directives (e.g. do not resuscitate) in either  referral letters or specialist letters. In some letters, a special heading regarding this subject  was available, but was often not completed. In addition, psychosocial information was only  very rarely found in either referral or specialist letters. One GP mentioned that psychosocial  information was almost never provided in letters, but that it was often shared during  telephone contact (e.g. Q9). Some specialist letters presented a summary of complaints in  organ systems other than the one of primary interest, but this was rare. Equally, it was rare  to receive a differential diagnosis of the other possible explanations for the complaints.  Q9: In case of malignancies, I always have contact by telephone with the treating  specialist in between his consultations. This provides me with relevant information  on how a patient is coping.  Interview with GP1. (Rural general practice, I1)  Reports  All patients were discussed at least once in a multidisciplinary meeting/ setting. In some  departments, the comprehensive reports of these meetings were sent to the GP. In other  departments, the report was available in the hospital file, but was not shared with the GP.  In those cases, the conclusions of the multidisciplinary meetings were often summarised in  the specialist letters. Some of these reports contained more information about alternative  treatment options and the choices made compared with the specialist letters (see Q10 and  Q11 for examples). Some GPs mentioned they would prefer to receive these reports, since  they often provide a summary of diagnoses and planned treatment. Other GPs thought  these reports did not add any value to the specialist letters.  Q10: Treatment plan: in case the patient prefers a breast saving treatment, there is  an indication for neo‐adjuvant chemotherapy. Otherwise mamma ablation and  axillary lymph node dissection.  Multidisciplinary meeting report. (Academic hospital, breast cancer, Doc101)  Q11: Treatment plan: modified radical mastectomy  Specialist letter. (Academic hospital, breast cancer, Doc12)  Q10 and Q11 are about the same patient at the same moment.  Reports of invasive diagnostic procedures (e.g. colonoscopy or bronchoscopy) were almost  always sent to the GP, either separately or integrated in a specialist letter. The same held  true for surgery reports. Reports from consultations with allied health professionals and  medical consultants were available in the patient’s file, but were not usually detailed in the  letter sent to the GP.  Telephone calls  Both GPs and oncology specialists mentioned that they preferred telephone contact when  dealing with oncological diagnoses. However, telephone calls to other healthcare providers  were rarely mentioned in either referral or specialist letters or somewhere else in the  patient file. In addition, both groups of healthcare providers mentioned that it was often  difficult to contact each other by telephone because of limited availability. Some GPs  6 73 Qualitative mixed-methods analysis of correspondence