Improving primary care involvement in cancer care

In a large survey among Dutch cancer patients, the call for more GP involvement shortly after cancer diagnosis was confirmed. The results also revealed that patients presently feel that their need for SDM support by the GP is inadequately met (Chapter 2). Our systematic review of (randomised) controlled trials on interventions to improve GP involvement in patients with cancer treated with a curative intent demonstrated that various types of interventions were reported, but most had low uptake and their results were heterogeneous. However, a shared observation was that patients generally reported more satisfaction with care when they received an intervention in which the GP was involved (Chapter 3).

The evaluation of the GRIP intervention facilitated detailed conclusions for each of the two components. The concept of a TOC with the GP was well accepted, given the fact that 4 out of 5 patients scheduled a TOC. Adequate timing of a TOC, however, proved challenging in the current health care system. The majority of patients (82%) in the GRIP trial had their TOC with the GP after the treatment decision in the hospital was already made.
This poor timing probably also explains the finding that patients in the intervention arm experienced reduced involvement in the treatment decision making process

The second part of the GRIP intervention, structured guidance during treatment by the GP and the homecare oncology nurse, was also well accepted, given the fact that almost 70% of the participants had at least 1 contact with the nurse. But again, implementation proved suboptimal, as almost half of the patients (46%) discontinued the schedule of follow-up visits by the homecare oncology nurse after treatment completion. The poor implementation of the two components affected the overall results of the GRIP program in the evaluation. After one year the intervention group had only a slightly increased number of contacts with the GP practice, and an increased use of the emergency department. We also found that, although satisfaction with overall care was comparable between the two groups (both high), patients in the intervention group were less satisfied with their GP. This may be explained by the fact that the increased GP involvement did not to meet their expectations (chapter 6).

In short; potential and need for primary care involvement seems obvious, but the design, evaluation and implementation of new interventions remains challenging. Continuous development of interventions to support primary care involvement in cancer care remains needed.