Ietje Perfors

194 Appendices The GRIP intervention In close collaboration with NFK, the University Medical Centre Utrecht and regional primary care healthcare workers we developed the GRIP intervention with structural involvement of the primary care team after cancer diagnosis. The study protocol of the GRIP trial is presented in chapter 4 . The GRIP trial is a multicentre, two-arm randomised controlled trial in the region of Utrecht, The Netherlands. Newly diagnosed patients with curable cancer (breast, lung, colorectal, gynaecologic, melanoma) from four Dutch hospitals were included. All patients received care as usual. The intervention arm received additional structured follow-up consisting of two parts: 1) a Time Out consultation (TOC) with the GP before onset of treatment to empower the patient for SDM with their specialist, and 2) support during and after cancer treatment provided by the HON in close cooperation with the GP. Repeated questionnaires, filled in by the participants, were assessed within the 1-year study period. These questionnaires were assessed at inclusion (T0), after 2 weeks (T1), after 6 months or at completion of active treatment (T3) and 3 months after active treatment (T5). Data of healthcare utilisation was retrieved from routine care data registrations in primary care and hospitals. First, we evaluated the first part of the GRIP intervention (Chapter 5), the TOC. As described above, patients in the intervention arm were offered to schedule a TOC with their GP immediately after they were diagnosed with cancer and prior to their treatment decision. Two weeks after inclusion, we evaluated the experienced SDM, information provision and self-efficacy. Our results showed that most patients were motivated to plan a TOC, since 80.5% (n=62) of the patients in the intervention group had a TOC. Yet, planning of a TOC seems challenging as 82.3% (n=51) of the TOCs took place after treatment decision. Perceived SDM was lower in the intervention group (0-100 scale, higher values equal higher experienced SDM: mean difference of -8.9 (95% CI, 0.6-17.1)) compared to the control group. Among those with a TOC before treatment decision (n=11), perceived SDM was comparable to the control group (66.5 SD ±27.2 vs 67.9 SD ±26.1). Since these groups were too small, effects of a timely TOC could not be established. Planning of the TOC should be optimised, and future research should establish if an adequately timed TOC results in improved SDM for cancer patients.