Ietje Perfors

77 Third, challenges and solutions may be setting and population specific. For these reasons, exploratory research seems necessary to design feasible and effective interventions and meaningful studies. Fourth, large studies with a robust design are needed, which should focus on the effect of primary care involvement for various populations, including specifications for cancer types and vulnerable populations (eg, elderly and patients with physical or mental comorbidity). Based on the findings in this review and guidelines for developing and evaluating complex interventions 29 and feasibility studies 30 , we propose a framework, which describes consecutive steps that can guide the future development of effective interventions (figure 3). In this framework, each step is aimed to provide a foundation for the next step, thereby providing a stepwise approach to feasible and meaningful involvement of the GP in cancer care. This framework should support us in finding definitive answers on the effects of GP involvement in the cancer care pathway in different healthcare settings, for a variety of populations. Interventions based on the framework should optimally facilitate primary care workers to appropriately implement their role in shared care, by making full use of their specific expertise by consideration of the patients’ context and values, provided in a trusted environment. Conclusion Literature addressing the effects of interventions designed to actively involve the GP during curative cancer treatment is scarce, and the results are diverse. Even though uptake of interventions is generally low, these studies suggest positive effects of increased primary care involvement on patient satisfaction. Other positive effects were seen, particularly for vulnerable populations. In view of various healthcare strategies, which aim to transfer parts of the cancer care paths from secondary to the primary care, it is adamant to gather more robust evidence for customised interventions to enable the efficient and effective involvement of the GP during cancer treatment. 3