Iris Kanera

16 Chapter 1 growing demand, which puts growing pressure on health care systems (Mayer et al., 2017). In 2007, the Health Council of the Netherlands concluded that aftercare for cancer survivors was insufficient in the Netherlands. Therefore, the Netherlands Comprehensive Cancer Organization (Integraal Kankercentrum Nederland) developed the guideline “Recovery from Cancer” (Herstel na Kanker; Comprehensive Cancer Centre the Netherlands, 2011b). This guideline provides a broad programmatic approach for oncology aftercare. Greater attention should be paid to the early recognition of survivors’psychosocial and lifestyle risks and needs during recovery and early cancer survivorship while self-management should be stimulated. It advises developing and implementing an individual survivorship care plan for each cancer patient/survivor (Aaronson et al., 2014; Comprehensive Cancer Centre the Netherlands, 2011b; Given & Given, 2013; Stanton et al., 2015). Implementing these guidelines into the care system is complex. The provision of appropriate information and gaining access to adequate psychosocial care and lifestyle support is challenging in the often very busy oncology settings (Krebber et al., 2012). Besides restricted time, health professionals also perceive a lack of knowledge and counseling skills to promote and support self-management and health behavior change (Anderson, Caswell, Wells, & Steele, 2013; Coa et al., 2015). Moreover, cancer survivors might also be reluctant to be referred to traditional forms of aftercare as described in the guideline for cancer rehabilitation, as these might not meet their current need (Comprehensive Cancer Centre the Netherlands, 2011a). Generally, referral rates to physical, psychosocial, and/ or lifestyle support appeared to be low, while many cancer survivors experience unmet needs (Aaronson et al., 2014). Therefore, the guideline Recovery from Cancer recommends setting up a custom-made supportive care plan and to apply a stepped care approach as an alternative care delivery system to provide more efficient and personalized aftercare (Krebber et al., 2012). In stepped care, a series of four steps are involved: (1) watchful waiting, (2) guided self-help, and other brief therapies, followed by (3) face-to-face problem solving treatments, and (4) other specialized interventions that are more intensive. In the first steps, a low intensive support might be sufficient to meet the personal needs of a large proportion of cancer survivors with relatively mild complaints and manageable needs of perceived limited complexity. Guidance during the first two steps includes a low intensive provision of information that mainly facilitates self-care, such as survivors’active participation in defining possible problem areas, setting goals, and making a personal action plan to address manageable problems. The more intensive interventions (e.g., face-to-face PST) are reserved for smaller proportions of cancer survivors with more intensive or complex care demands, who do not benefit sufficiently from low intensive interventions (Aaronson et al., 2014; Krebber et al., 2012). This thesis focusses on the development and evaluation of a low intensive self-management intervention for cancer survivors.