Ietje Perfors

196 Appendices Evidence for effective interventions aimed at GP involvement is limited and the GRIP intervention does not yet offer a conclusive solution. It seems that the TOC with the GP between diagnosis and choice of therapy meets the needs of the cancer patient. Yet, the integration of TOC in daily care pathways and the collaboration between GP and HON needs to be improved. For improvement of both the intervention and research, we advise to follow the steps of the MRC model for evaluation of complex interventions. This model highlights elements such as development, feasibility, evaluation and implementation. If development of a structured primary care intervention in cancer is strived for, it is recommended to critically examine the conditions for successful embedding a TOC in the oncological pathway, before it can be effectively integrated. Furthermore, the desired role of the GP and HON after the diagnosis of cancer should be further examined, in order to better provide support from the primary care team. After development, pilot studies should also be executed to test and optimise the “feasibility” of the intervention. Based on this dissertation, we have some recommendations to facilitate the future development of primary care involvement: • Consider adequate structured cancer care not as a primary care goal, but as a shared goal for personalised cancer care. This means that effective GP involvement after diagnosis should be developed and implemented together with both primary care teams and hospital teams. • The task differentiation and delegation in cancer care needs to be further developed, both interprofessionally as well as between general practice and hospital care. For example, the collaboration between the GP and the home care oncology nurses in the GRIP intervention was not yet matured. • Complex interventions such as shared cancer care, in which the primary care is given a structural role, will have to be subject to continuous evaluation. We recommend that a new approach is always evaluated in a pilot study before a large-scale study is performed.