Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer

Abstract

Objective To examine the influence of patient and physician communication factors on diagnostic delay (DD). Methods 242 patients diagnosed with colorectal cancer (CRC) in the past 6 months who experienced symptoms prior to diagnosis were administered a 2-hour semi-structured qualitative interview to assess communication with health care provider and ease of access to care, among other factors. Patient-provided information was verified via review of medical records. Results The factors associated with DD > 2 months included lower income (OR=0.56, p=0.03), having regular physician prior to receiving a cancer diagnosis (OR=2.52, p=0.03), having a physician who used temporizing communication strategies during the consultation (OR=2.41, p=0.02), receiving an initial alternate diagnosis (OR=3.36, p=0.02), experiencing referral delay (OR=3.61, p=<0.001), and experiencing follow-up delay of any kind (OR=3.32, p=0.01). Conclusion Excellent communication skills that appropriately probe for relevant social and economic patient information, assist patients in distinguishing and elaborating on symptoms, and provide clear rationale and instructions for future steps, will speed along the diagnosis process and could be the difference between early and late stage CRC. Practice Implications Increased understanding of physician communication and practice styles that contribute to DD could have a positive impact on decreasing the morbidity and mortality from this disease.

Do diagnostic and treatment delays for colorectal cancer increase risk of death?

“…Third, by limiting delays to a maximum of 365 days (diagnostic) and 120 days (treatment), we may be artificially capping longer delays therefore biasing our results toward the null. However, based on previous research,[16,59,51,9,60] we suspect that the vast majority of patients, particularly a Medicare-insured population, have diagnostic delays within this range. Fourth, in our attempt to be as precise as possible when identifying the diagnosis date, we applied a strict algorithm, which limited the size of our sample and potentially the generalizability of our findings.…”

How does the thought of cancer arise in a general practice consultation? Interviews with GPs

“…Our doctors emphasized a receptive, sensible awareness that was seen as a premise for recognizing clinical cues [23,24]. Thus, the thought of cancer arose in the relationship between doctor and patient.…”

Coping With Prediagnosis Symptoms of Colorectal Cancer

“…Study methods including recruitment methodology, participants and interviews have previously been described 14 . In short, 252 interviews were conducted with CRC patients recruited from five academic and community oncology practices in Virginia and Ohio.…”

“…This is a well-accepted approach successfully used by others 14, 20–22 . The codes for each interview question were generated from iteratively coding interviews until thematic saturation was reached, which occurred after approximately 50 transcripts.…”