Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2021 Apr;30(4):571-580.
doi: 10.1002/pon.5604. Epub 2020 Dec 22.

Effects of a time out consultation with the general practitioner on cancer treatment decision-making: a randomised controlled trial: Time out with the general practitioner and cancer treatment decision

Ietje A A Perfors  1 , Eveline A Noteboom  1 , Niek J de Wit  1 , Elsken van der Wall  1 , Ella A Visserman  2 , Thijs van Dalen  3 , Marc A M T Verhagen  3 , Arjen J Witkamp  1 , Ron Koelemij  4 , Annebeth E Flinterman  3 , Eleonora B L van Dorst  1 , Kim A B M Pruissen-Peeters  4 , Leon M G Moons  1 , Franz M N H Schramel  4 , Marcel T M van Rens  3 , Miranda F Ernst  5 , Anne M May  1 , Charles W Helsper  1
Affiliations
Randomized Controlled Trial

Effects of a time out consultation with the general practitioner on cancer treatment decision-making: a randomised controlled trial: Time out with the general practitioner and cancer treatment decision

Ietje A A Perfors et al. Psychooncology. 2021 Apr.

Abstract

Objective: Improving shared decision-making (SDM) enables more tailored cancer treatment decisions. We evaluated a Time Out consultation (TOC) with the general practitioner (GP), between cancer diagnosis and treatment decision, which aims at supporting SDM and improving continuity of primary care. This study aims to evaluate the effects of a TOC on perceived SDM, information provision and self-efficacy.

Methods: This randomised controlled trial included newly diagnosed patients with curable cancer (breast, lung, colorectal, gynaecologic and melanoma) from four Dutch hospitals. Primary outcome is perceived SDM and secondary outcomes are information provision and self-efficacy.

Results: One hundred fifty-four patients (control n = 77, intervention n = 77) - female: 75%, mean age: 61 (SD ± 11.9). In the intervention group, 80.5% (n = 62) had a TOC, of which 82.3% (n = 51) took place after treatment decision. Perceived SDM was lower in the intervention group (-8.9 [95% CI: 0.6-17.1]). Among those with a TOC before treatment decision (n = 11), perceived SDM was comparable to the control group (66.5 ± 27.2 vs. 67.9 ± 26.1).

Conclusion: Even though patients are motivated to have a TOC, implementing a TOC between diagnosis and treatment decision is challenging. Effects of a timely TOC could not be established. Non-timely TOC decreased perceived SDM. Planning of the TOC should be optimised, and future research should establish if adequately timed TOC results in improved SDM in cancer patients.

Keywords: cancer; decision-making; general practitioners; neoplasms; physicians; primary health care; psycho-oncology.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflict of interest.

Niek J. de Wit, Elsken van der Wall, Anne M. May and Charles W. Helsper designed the GRIP trial. Thijs van Dalen, Marc A.M.T. Verhagen, Arjen J. Witkamp, Ron Koelemi, Annebeth E. Flinterman, Eleonora B.L. van Dorst, Kim A.B.M. Pruissen‐Peeters, Leon M.G. Moons, Franz M.N.H. Schramel, Marcel T.M. van Rens and Miranda F. Ernst conducted the selection and inclusion of patients. Ietje A.A. Perfors and Eveline A. Noteboom performed the trial execution, the data analysis and drafted the paper, under supervision of Niek J. de Wit, Elsken van der Wall, Anne M. May and Charles W. Helsper. All authors read, revised and approved the final version of the manuscript.

Figures

FIGURE 1
FIGURE 1
Consolidated Standards of Reporting Trials (CONSORT) flow diagram of the GRIP study after 2 weeks (T1)
See this image and copyright information in PMC

References

    1. Worldwide Cancer Incidence Statistics: Cancer Research UK. 2019. https://www.cancerresearchuk.org/health-professional/cancer-statistics/w.... [Cited October 2, 2019].
    1. Signaleringscommissie . Nazorg bij kanker: de rol van de eerstelijn. Amsterdam: KWF Kankerbestrijding; 2011. https://docplayer.nl/10326502‐Nazorg‐bij‐kanker‐de‐rol‐van‐de‐eerste‐lij...
    1. Ogle KS, Swanson GM, Woods N, Azzouz F. Cancer and comorbidity: redefining chronic diseases. Cancer. 2000;88(3):653‐663. - PubMed
    1. Sarfati D, Koczwara B, Jackson C. The impact of comorbidity on cancer and its treatment. CA Cancer J Clin. 2016;66(4):337‐350. - PubMed
    1. Hurtaud A, Aubin M, Ferrat E, et al. Continuity of care in general practice at cancer diagnosis (COOC‐GP study): a national cohort study of 2853 patients. Br J Gen Pract. 2019;69(679):e88‐e96. - PMC - PubMed

Publication types