Striking the right balance in colorectal cancer care--a qualitative study of rural and urban patients.
BACKGROUND
Colorectal cancer is the second most common cause of cancer-related death in Scotland. For patients, the journey from diagnosis through treatment is complex and there are inequalities in survival rates.


OBJECTIVE
The aim of the present study was to explore how patients with colorectal cancer perceive their care.


METHODS
This was a qualitative study involving 95 patients and relatives of patients with colorectal cancer in the North, Northeast and Northern Isles, Scotland. Focus groups (32 participants) were conducted in hospital, and interviews (63 participants) in patients' own homes in order to explore their experiences of health services for cancer-what was good, what was bad and what was needed. Analysis was inductive, with exploration of similar and divergent perspectives within themes.


RESULTS
Patients wanted rapid diagnosis, specialist treatment and good communication, but their experiences of and perspectives on these areas were often divergent. Delays in diagnosis could stem from late presentation by patients, but also from early presentation when the cancer could go undetected. GP continuity was desirable, but sometimes implicated in delays. Patients preferred their GPs to be advocates, not gatekeepers. The context, however, was one where some patients pursued their care tenaciously while others did not. For some, speed of progress through the system was everything, but others found this could be impersonal. Outlying patients had to balance transport difficulties with the benefits of distant specialist treatment. Some patients wanted full information to be provided directly, but others could not cope with this.


CONCLUSIONS
From patients' perspectives, ideal cancer care cannot be achieved in a uniform way. For some of the key goals of cancer treatment to be met, including rapid access to specialist treatment for all and good communication of bad news and test results, a balance must be struck which tailors care to individuals.
Department of General Practice and Primary Care, Foresterhill Health Centre, Aberdeen University Medical School, Westburn Road, Foresterhill, Aberdeen AB25 2AY, Scotland, UK.
Norma S C
NS
Bain
Neil C
NC
Campbell
Lewis D
LD
Ritchie
Jim
J
Cassidy
D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000628:therapy*; D003142:Communication; D003266:Continuity of Patient Care; D005194:Family Practice / Q000592:standards*; D005260:Female; D017144:Focus Groups; D006302:Health Services Research; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D010817:Physician-Patient Relations; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012424:Rural Population; D012606:Scotland; D014505:Urban Population