Patients with cancer need more involvement of their GP after the diagnosis in the hospital. For example, in joint decision making for the treatment. However, planning this is a challenge, as shown by the GRIP study carried out by the UMC Utrecht. The UMC Utrecht has cooperation agreements with other hospitals and general practitioners in the region to improve counselling of patients with cancer. 

It is important for patients to have a say in their treatment, so that it matches their preferences and priorities. The number of treatment options is increasing, people live longer and quality of life is becoming increasingly important. The general practitioner can play a supporting role in this decision-making process. 

Commitment improve

In mid-September Ietje Perfors obtained her PhD as a general practitioner in training on interventions that stimulate more involvement of the general practitioner after cancer diagnosis. She conducted a randomized controlled study to examine the GRIP intervention, for example. The GRIP intervention aimed to improve both the structured guidance of patients with cancer by general practitioners and to better involve patients in treatment decisions. Health scientist Eveline Noteboom obtained her PhD in mid-October and studied the role of the general practitioner and that of patients in the decision-making process for cancer treatment. One of the ways in which she did this was through qualitative research into a part of the GRIP intervention: the Time-Out Consultation (TOC) with the general practitioner. 

GRIP intervention

Previously researched interventions to improve the involvement of general practitioners with cancer patients showed that these were often not carried out as planned and that the results for patients were not unambiguous. In close cooperation with the Dutch Federation of Cancer Patient Organisations (NFK) and regional primary care providers, a team from the UMC Utrecht developed the GRIP intervention. The GRIP intervention consists of two components. The first component is the TOC: this is a consultation with the general practitioner just after the diagnosis, in which the general practitioner prepares the patient for the choice of treatment in the hospital. The second component consists of regular guidance during and after treatment by the primary oncology nurse in collaboration with the general practitioner. 

After the choice of treatment

A survey conducted by Ietje and Eveline in collaboration with NFK shows that 82% of patients want their general practitioner to listen to concerns and considerations about their diagnosis, treatment and consequences. Ietje says, “Patients are motivated to visit the general practitioner for a TOC, but good timing appears to be a challenge. In more than 82% of cases in the GRIP study, a patient did not talk to the general practitioner until the choice of treatment had already been made in the hospital.” One reason for this is the rapid diagnosis in the hospital. 

Integrated in care path

The conclusions from Eveline’s research into the TOC are consistent with Ietje’s findings. Eveline says, “The TOC can strengthen the role of patients in joint decision-making and can lead to a more personalized treatment choice. Patients experience psychological support from general practitioners after the diagnosis and appreciate it. In the GRIP study, the TOC unfortunately came – simply put – too late in the day for many patients. In addition, patients were not always aware that there was a choice in treatment. In order to involve the general practitioner in good time after cancer diagnosis and to integrate the TOC in the day-to-day care path for cancer patients, cooperation between the specialist and the general practitioner needs to be improved. To this end, it is important that the wishes of patients are continuously highlighted by the specialist and the general practitioner. Moreover, guidelines laying down agreements on responsibilities and communication are needed.”

Regional transmural appointment

Internist-oncologist Alexander de Graeff was involved on behalf of the UMC Utrecht in establishing a regional transmural arrangement for oncological care in the Utrecht region at the initiative of the professional healthcare network Trijn. It lays down agreements on structured cooperation between primary and secondary care in the treatment and guidance of patients with cancer. Alexander says, “Unfortunately, the GRIP study did not prove that a TOC leads to more shared decision-making, but that’s mainly because in many cases the TOC was only conducted after the choice of treatment had been made. However, specialists, general practitioners and oncology nurses in the region are convinced of the use of a TOC. That’s why we laid this down in the regional transmural arrangement. After a patient has been informed in the hospital about the diagnosis and treatment options or the proposed change of treatment, the specialist informs the patient of the option of a TOC with the general practitioner. It goes without saying that we are committed to having this conversation actually take place prior to the choice of treatment. In practice, this is not always easy, partly because a patient wants to receive a diagnosis quickly and also wants to start treatment quickly. So we really need to make time for it.”