Ietje Perfors

74 Chapter 3 Discussion This systematic review shows that published research describing the effect of interventions designed to involve the GP during curative cancer treatment is scarce. The six studies that were published evaluate either additional information transfer to the GP or tailored primary care. In general, the intervention uptake was low, and the risk of bias was low to moderate. Results indicate a positive effect of increased GP involvement in cancer care on patient satisfaction with care but not on quality of life. In subgroups, it may lower healthcare use and anxiety. Even though active involvement of the GP during cancer treatment might have positive effects, implementation appears to be difficult to realise. This is seen for all interventions, irrespective whether the GP contact is initiated by the patient or by the healthcare provider. This shows that finding a feasible intervention is challenging. Drury et al 25 suggested that a reason for the low uptake might be that GPs are not motivated to participate in the care of patients with curative disease as they do not feel closely involved in this stage. 25 This may explain why no studies were found where the GP was the initiator of involvement in care during cancer treatment. Low GP motivation is in contrast to what Dossett et al 27 show in their review on communication of specialist and GP during the cancer care continuum, they state that GPs desire involvement but think that specialist and patient prefer a specialist- based instead of shared-based cancer care. 27 Dossett et al 27 confirms a preference of a specialist-based model of care by specialists, which may result in a low motivation to activate the patient to see the GP. 27 Another reason for low uptake may be the difficulty to promote proactivity by GPs. 18, 19 Dossett et al 27 suggest that an adequate relationship and communication between the specialist and GP are important elements for the success of an intervention. 27 These findings suggest that, when designing an intervention, raising support of both primary and secondary healthcare workers is vital. The fact that healthcare systems have different challenges and needs (eg, communication between caregiver or distance to healthcare services), strengthens the need to tailor the potential solutions to local needs.