Ietje Perfors

98 Chapter 4 Discussion The aimof the GRIP study is to assess the effects of structured follow-up from primary care after the diagnosis of cancer on satisfaction and healthcare utilization of patients treated with curative intent. To optimise personalised cancer care for a growing patient population and for effective implementation of structured follow-up from primary care, policymakers and professionals need more information on the effects of structured and continuous primary care involvement in the cancer continuum. The GRIP study will provide evidence on the effects on patient satisfaction and healthcare utilization and secondary outcomes. In this pragmatic study, patients with multiple cancer types will be included aiming at high generalizability of the results. It will be explored whether there are subgroups of patients for whom this structured primary care works best. In this protocol some choices were made, that need clarification. First, we chose to assess the addition of structured follow-up from primary care by a GP and HON to care as usual instead of substitution of the supportive care provided in hospitals. This choice was made because we believe it is not feasible nor desirable to completely replace supportive care provided from secondary care by that from the primary care team. In addition, we aim to test the assumption that additional care from primary care will lead to a shift of the utilised care from the secondary to the primary care setting. Second, patient satisfaction and healthcare utilisation are chosen as primary outcomes, since these factors are consideredmost relevant from the perspective of patient and society. Third, for the secondary outcome ‘patient empowerment’, so far, no uniform definition and no unique measurement tools exist. Therefore, we chose to use two validated questionnaires (GSE and Pearlin Mastery Scale) to estimate the effect of our intervention on patient empowerment. Although in previous intervention studies during cancer treatment comparable numbers of questionnaires were acceptable, the use of several questionnaires might induce loss to follow-up. Last, we had to choose between random assignment at the patient or the caregiver level. We chose to randomise on patient level, using type of cancer