Ietje Perfors

179 care and the patients’ expectations. It seems that the intervention may have raised expectations about GP involvement in the intervention group, that were not met during the trial. Our intervention registrations indicate that, while we presented the follow-up care as a joint effort of the primary care team, the homecare oncology nurse, and not the GP became themain provider of follow-up care in daily practice. This mismatch between expectations and reality, namely being seen by the GP instead of the homecare oncology nurse, may have resulted in disappointment, and negatively influenced the perception by the patients of the GP’s role. We did not assess patients’ expectations, but literature shows that met expectations positively influence satisfaction measurements. 4 This suboptimal role distribution between GP and homecare oncology nurse was probably due to the fact that the setting for their cooperationwas new. GP’s and home care nurses are used to working together in elderly care, in home care and in palliative care, and also in these fields has taken time to reach agreement about professional roles and responsibilities, and define the optimal model of collaboration. Generally, the process of interdisciplinary task delegation and differentiation in healthcare is complex and implementation is time consuming. It needs to be matched with the patients’ expectations, and at an organisational level, it needs to be facilitated by adequate financial reimbursement, information exchange, staffing and training. We would strongly advise all these aspects to be further developed, in order to optimize the collaboration between GP and home care nurse in the follow-up care of cancer patients outside the hospital. Evaluation of complex healthcare interventions; design and methodological challenges Interventions intended to improve primary care involvement, such as the GRIP intervention, are complex interventions. Complex interventions are generally multifaceted and include several interacting components. 5 This requires conscious design and adequate evaluation methodology. The MRC Framework for the Development and Evaluation of RCTs for Complex Interventions to Improve Health, provides guidance for the design and evaluation of complex interventions (Figure 1). 6 7