Iris Kanera

7 171 General Discussion support without referral. It might be expected that the number of KNW visitors would be limited without indication to it from an oncology professional. Still, a different target group might be reached, e.g., those who prefer searching for and choosing a suitable program themselves. A higher number of survivors would be reached, when integrating the KNW in the process of setting up an individual survivorship care plan after completing primary cancer treatment, as advised in the guidelines ‘Recovery from Cancer’ (Comprehensive Cancer Centre the Netherlands, 2011b). First, during the consultation with an oncology professional, the KNW (i.e., online assessment and the personalized MRA) might contribute to identifying individual problem areas that may be helpful in decision-making for subsequent aftercare. Second, using the KNW content can be one of the possible aftercare options. According to the stepped-care approach, the KNW might be beneficial as web-based guided self- help, particularly for survivors with relatively mild complaints (Krebber et al., 2012). The way Dutch cancer aftercare is currently organized, cancer survivors with mild complaints usually are often excluded from support for recovery, and the KNW may fill a gap in cancer aftercare. Third, the KNW can be embedded into the general practice care. Currently, general practitioners play an increasingly important role in cancer aftercare when tasks of oncology specialists are moved to primary health care (Nederlands Huisartsen Genootschap [NHG], 2014). Fourth, the KNW can also be used alongside and in combination with the traditional face-to-face forms of aftercare, as well as in mono-disciplinary settings (e.g., oncological physiotherapy, psychological support) and interdisciplinary settings (e.g., oncological rehabilitation), since the KNW content fits with the national guidelines for oncological rehabilitation (Comprehensive Cancer Centre the Netherlands, 2011a). When embedding the KNW into the general practice and/or combining the intervention with face-to-face support, we expect to reach a broader group of cancer survivors, including survivors with different types of cancer, higher ages, higher risks and needs, and a longer time since treatment completion. Importantly, KNW effects on possible new subgroups should be evaluated. GENERAL CONCLUSIONS This thesis supports prior research that asserts there is a need to enhance cancer survivors’ lifestyle behaviors, and that a web-based tailor-made approach may be useful to promote a healthy lifestyle. It furthermore indicates the usefulness and potential effectiveness of an online stand-alone intervention to respond to the growing demands of comprehensive and personalized cancer aftercare. The systematically developed, theory-grounded, web- based, tailored KNW intervention is aimed at supporting healthy lifestyle behaviors and psychosocial issues in order to increase survivors’ QoL.