Ietje Perfors

176 Chapter 7 Aim of this thesis This thesis focussed on structural involvement of the general practitioner (GP) in the cancer care pathway. On this topic, we assessed the patients’ needs (Chapter 2), gathered the available evidence from interventions aiming to achieve this (Chapter 3), and presented the design of the GRIP intervention (Chapter 4). GRIP aimed to improve primary care involvement from diagnosis onwards and included two components: First, patients were offered a Time Out consultation (TOC) with the GP, aimed to support shared decision making (SDM) on cancer treatment. Second, patients were offered structured guidance during and after treatment by the GP and a homecare oncology nurse. The effectiveness of the GRIP intervention was assessed in a large randomised controlled trial (RCT) in the region of Utrecht among cancer patients treated with a curative intent, involving all hospitals, GPs and homecare organisations (Chapters 5 and 6). In this final chapter, the main results are summarized. We also reflect on the methodological and organisational challenges we encountered. Finally, we describe lessons learned and suggest a roadmap to enlarge the role of primary care in the cancer care path. Main findings In a large survey among Dutch cancer patients, the call for more GP involvement shortly after cancer diagnosis was confirmed. The results also revealed that patients presently feel that their need for SDM support by the GP is inadequately met (Chapter 2). Our systematic review of (randomised) controlled trials on interventions to improve GP involvement in patients with cancer treated with a curative intent demonstrated that various types of interventions were reported, but most had low uptake and their results were heterogeneous. However, a shared observation was that patients generally reported more satisfaction with care when they received an intervention in which the GP was involved (Chapter 3).