Ietje Perfors

178 Chapter 7 Lessons learned Disappointingly, the GRIP program did not show favourable outcomes in the RCT. Several lessons were learned that may help to improve future interventions aiming at enlarging the involvement of the GP in cancer care. The concept of a TOC between the cancer diagnosis and treatment choice, although broadly supported, does not seem to fit in the cancer care pathway as it is presently organised. One of the key factors is a lack of time between diagnosis and therapy choice. This is related to two factors. For most patients the cancer diagnosis is regarded as an imminent threat of life expectancy, and immediate removal of the cancer is perceived as mandatory. Waiting times for treatment are associated with even more psychological burden. To limit this burden, oncologists have put in every effort to limit the time between diagnosis and start of treatment 1 and hospital s have organised ‘short track routes’ for treatment planning after cancer diagnosis, including frequent multidisciplinary team discussions and fast treatment schedules. These efforts leave limited time for deliberationwith the patient about the preferred treatment choice, even in hospital practice. In addition, it is even more challenging to get the GP involved in supporting the patient in the decision making process. There seems wide recognition by patients and professionals for the added value of the GP in empowering the patient for SDM 2, 3 given the longitudinal relation with the patient and the importance of individual context and personal preferences. In the current cancer care pathway, integration of a TOC before treatment choice is only possible if primary and secondary care actively match appointment schedules, and if oncologists timely transfer information to the GP. In addition, all professionals should communicate to the patient that SDM is of key importance, thereby jointly communicating that the GP is best positioned to support the patient in decision making and that the extra time required for the GP visit will not affect life expectancy. As for the primary care guidance during and after treatment, the suboptimal adherence to the scheduled homecare oncology nurse consultations wasmost likely related to a suboptimal fit between the content of the GRIP follow-up