Table 1 Patient eligibility criteria

Patient inclusion criteria

1. patients diagnosed with metastatic or locally irresectable cancer

2. not eligible for treatment with curative intent

3. a median life expectancy of < 1 year without systemic treatment, and a median survival benefit of systemic treatment of < 6 months, which includes, but is not limited to:

 a. patients with metastases or locally irresectable tumors of the pancreas, esophagus, stomach, liver, (gall) bladder, and patients with metastatic sarcoma or melanoma

 b. patients with advanced cancer, irrespective of tumor type, who have experienced progression under first line palliative systemic treatment.

4. scheduled for a consultation with a participating medical oncologist (in training) in which decisions about the start, (dis)continuation or adjustment of palliative systemic treatment will be made. This includes:

 a. initial consultations in which a decision to start, forego or postpone a (new line of) systemic treatment will be made

 b. evaluative consultations in which current treatment is evaluated, usually after a fixed number of cycles (with a CT/PET-CT) and a decision to (dis)continue and/or adjust systemic treatment will be made

Patient exclusion criteria

1. patients who have insufficient mastery of Dutch to understand the communication aid and questionnaires as judged by either the physician or the researcher

2. cognitive disabilities or a psychiatric disorder that hinder understanding of the communication aid and questionnaires as judged by either the physician or the researcher

3. insufficient time between identification and consultation (< 2 working days)

4. a primary brain tumor or brain metastasizes which significantly hinder cognitive functioning

5. not/no longer/not yet eligible for (an additional line of) palliative systemic treatment (standard or experimental), which prevented discussion of systemic treatment as judged by the physician

6. insufficient diagnostic information available, which prevented discussion of systemic treatment as judged by the physician