Ietje Perfors

177 The evaluation of the GRIP intervention facilitated detailed conclusions for each of the two components. The concept of a TOC with the GP was well accepted, given the fact that 4 out of 5 patients scheduled a TOC. Adequate timing of a TOC, however, proved challenging in the current healthcare system. The majority of patients (82%) in the GRIP trial had their TOC with the GP after the treatment decision in the hospital was already made. This poor timing probably also explains the finding that patients in the intervention armexperienced reduced involvement in the treatment decision making process The second part of the GRIP intervention, structured guidance during treatment by the GP and the homecare oncology nurse, was also well accepted, given the fact that almost 70% of the participants had at least 1 contact with the nurse. But again, implementation proved suboptimal, as almost half of the patients (46%) discontinued the schedule of follow-up visits by the homecare oncology nurse after treatment completion. The poor implementation of the two components affected the overall results of the GRIP program in the evaluation. After one year the intervention group had only a slightly increased number of contacts with the GP practice, and an increased use of the emergency department. We also found that, although satisfaction with overall care was comparable between the two groups (both high), patients in the intervention group were less satisfied with their GP. This may be explained by the fact that the increased GP involvement did not to meet their expectations (chapter 6). We conclude that, although increased involvement of the GP and homecare oncology nurse clearly did address the needs of the cancer patient, implementation of the TOC and scheduled homecare oncology nurse follow-up visits in primary care needs to be improved in order to reach the intended ambition. This requires a less tight time-schedule in the cancer care path where patients, following the primary diagnosis, are supported by a consultation with their GP tomake a well-balanced decision. The suboptimal adherence to the intended homecare oncology nurse consultations during treatment needs further evaluation. 7