Ietje Perfors

195 In chapter 6, the second part of theGRIP intervention is evaluated. We assessed the effects of guidance by an HON in collaboration with the GP, during and after cancer treatment, on the primary outcomes of patient satisfaction and healthcare use. Secondary outcomes were quality of life, mental health and self-efficacy. We found that 68%of the intervention patients had at least one HON contact, which showed that the initial acceptance was good. However, the implementation of HON contacts was suboptimal as almost half of the patients (46%) did not complete the recommended contacts with HON after treatment. Overall patient satisfaction with care in both study groups on T3 and T5 was high (an average score of 8 on the scale 0-10). Three months after completion of oncological treatment (T5), satisfaction with the GP was significantly lower in the intervention group compared to the control group measured on 3 out of the 6 subscales (on a 0-100 scale, with higher satisfaction at higher values). We found mean differences between the intervention and control group of -14.2 (95% CI -27.0;-1.3) for the quality of the GP, -15.9 (-29.1;-2.6) for the availability of the GP and -15.2 (95% CI -29.1;-1.4) for the provision of information. This may be the result of sub-optimal expectation management, caused by the newly introduced care path where the division of roles between GP and HON was not yet matured. Patients in the intervention group visited GP practices and emergency care more often than the control group (RR 1.3 (95% CI 1.0;1.7) and RR 1.70 (95% CI 1.0;2.8) respectively). The other outcomes did not show differences between the intervention and the control group. In conclusion, the GRIP intervention, which aimed to better involve a primary care team during and after cancer treatment, slightly increased the number of contacts in primary care. Yet, timely planning of the TOC proved to be challenging and patient satisfaction with care did not improve. The emergency department was also visited more often. The high degree of acceptance of both components of the intervention (TOC and HON) suggests that such an intervention meets the needs of the patient. The sub- optimal implementation and effects indicate that the intervention needs to be further improved. Future research should further optimise and evaluate the structure and implementation of the intervention. In conclusion, patients express a need for GP support after their cancer diagnosis. Particularly for SDM, GP support is now experienced infrequently.