Ietje Perfors

180 Chapter 7 Following the steps of the MRC Framework, we now critically evaluate the process of the GRIP intervention, aiming to provide guidance or improved intervention models targeting GP involvement in cancer care in the near future. Figure 1. Key elements of the development and evaluation process. Source: The MRC Framework for the Development and Evaluation of RCTs for Complex Inter- ventions to Improve Health (depicted fromMRC 6 ) 1. Development In retrospect, earlier identification of the available evidence from the literature could have improved the “Development process” (figure 1) of the GRIP intervention. Choices in the design of the GRIP trial were based on several recent publications, e.g. Wagner et al., but not on systematic review of the literature. 7 If the systematic review on primary care interventions in cancer care was performed upfront, it could have informed the GRIP developing team that f.i. the outcome ‘quality of life’ is usually difficult to improve; that in general a low uptake of complex interventions is to be expected and that special attention for vulnerable populations is warranted, given the fact that effectiveness in these subgroups is often higher. In addition, according to the MRC Framework it is important to “develop a theoretical understanding of the likely process by using existing evidence”, for example supplemented by interviews with stakeholders. We mainly consulted stakeholders, formal organisational reports and had informal conversations with the GPs, homecare oncology nurses, specialists and patient advocates, to comment on our present theoretical framework. We