Mariken Stegmann

Strengths and limitations  To the best of our knowledge, this is the first study not to use pre‐specified quality criteria  when analysing the content of letters concerning patients with cancer. We gathered  information in a very open and explorative way, as is needed in qualitative research, 25  and  much attention was paid to the sample composition. Indeed, we generated a purposive  sample of patients by different hospital types, different cancer types and different tumour  stages, and we included both GPs and oncology specialists of different ages and genders.  Interviews were also included to ensure data triangulation. Despite the fact that our  research was aimed at correspondence about patients with cancer, the findings seem to be  not very disease specific and may be generalisable to other diseases.  However, several limitations do exist. First, all researchers who analysed the data for coding  were associated with our Department of General Practice, and this might hamper  objectivity. To combat this, however, a value‐free code list was used and all results were  discussed extensively with co‐authors working in different hospital departments. Second,  only written information was used because of the nature of the content analysis. Non‐ recorded phone calls between healthcare providers were, therefore, not included. Although  this does not mean that none occurred, we assume that transparency and continuity of care,  as well as medico legal considerations, would mean that notes would have been made of  these contacts. Related to this point, our sample only contained letters from the initial  treatment period. This may be relevant to items such as late side effects, which often were  not mentioned in the present sample, but which might have been mentioned in specialist  letters at the end of treatment.  Considerations  In the Netherlands, as in other countries, hospitals are now developing a patient record file  that cannot only be used by specialists but also by other healthcare providers, such as GPs,  and by patients. Consequently, it can be expected that such files will comprise a lot of  information, of varying relevance, and that will contain notes from different healthcare  providers. This growth in information may make it increasingly difficult to identify the most  relevant data; therefore, exchanging summaries of relevant information would appear to be  of critical importance.  Conclusion  General practitioners and oncology specialists exchange a lot of information in  correspondence. In this study, we identified certain problems that were specific to referral  letters and others that were specific to specialist letters. Notably, referral letters suffered  from a lack of focus, which probably reflected a failure to use referral templates correctly. By  contrast, although specialist letters included information about actual treatment, other  information relevant to primary care was often missing; this included the intent of the  treatment (curative or palliative), the alternative treatment options and the details of any  discussion with patients. Our findings indicate that neither referral nor specialist letters are  tailored to the needs of the recipient. Further re‐ search should focus on the information  different healthcare providers would like to receive. In the meantime, however, it seems  prudent to recommend that all correspondence should be written with the receiver in mind  and that summaries of relevant information be included in a prominent position in all  correspondence.  6 75 Qualitative mixed-methods analysis of correspondence