Ietje Perfors

184 Chapter 7 but we could only realise an additional care intervention, since adjustments in the cancer care pathway in the hospital were not broadly supported and difficult to realise. Facilitation of contextual factors by healthcare management and policy makers such as dedicated time, staff and financial reimbursement is vital for successful implementation. 14 Within the Dutch healthcare system there was financial reimbursement present to support implementation of the GRIP trial. At first instance, a lack of time was foreseen for GP’s, but this was overcome by involving the homecare oncology nurse. However, this might have resulted in dissatisfaction of patients. In conclusion, although we did follow the MRC framework when designing and evaluating the GRIP intervention, we did not complete all the necessary steps to the required level of detail. In retrospect, better planning of the intervention (i.e., better coordination between all stakeholders involved), outcomes, and especially a pilot study might have prevented some of the implementation problems that we encountered. Primary care involvement in cancer care; future de- velopments and recommendations Primary care involvement in future cancer care remains of growing importance. Worldwide, the number of patients that have or had cancer continues to rise, a growth which is not expected to decline in future years. At the same time, scientific breakthroughs result in gradually expanding opportunities in diagnostics, treatments and in ways of supportive and palliative care. Cancer patients are therefore exposed to an increasing number of options, sometimes requiring difficult choices to be made in determining their personal cancer care path. As the general practitioner, of all healthcare providers, usually is the most ‘nearby’ healthcare professional, who is most familiar with comorbidities and the psychosocial and cultural issues of their patients, structural involvement of the GP in the cancer care path could help cancer patients to make well-balanced choices.