title: Minimizing delays in ovarian cancer diagnosis: an expansion of Andersen's model of 'total patient delay'.
abstract: BACKGROUND
  Ovarian cancer symptoms are vague and commonly occur in benign conditions; it often presents late and is diagnosed at an advanced stage when survival rates are poor. Studies of diagnostic delay in conditions with non-specific symptoms are rare.
  
  
  OBJECTIVE
  To study accounts of diagnostic delays in a sample of British women with ovarian cancer using Andersen's five-stage model of 'total patient delay' as an analytic framework.
  
  
  METHODS
  Semi-structured interviews were conducted with 43 women. Maximum variation sample was recruited via GPs, clinicians, support organizations and personal contacts.
  
  
  RESULTS
  Most women reported pre-diagnostic symptoms and diagnostic delays. Patient delays conformed to Andersen's first four types: 'appraisal, illness, behavioural and scheduling' delays. 'Treatment delays', attributable at least in part to a doctor or the health care system, were common and we have broken them down into five categories: non-investigation of symptoms, treatment for non-cancer causes, lack of follow-up, referral delays and system delays.
  
  
  CONCLUSIONS
  Our data illuminate the reasons why some British women experience delays in obtaining an ovarian cancer diagnosis. Delays attributable to the women were often compounded by doctor or health service delays, enabling us to expand the fifth stage of Andersen's model. Diagnostic delays in general practice could be minimized by better history taking, explaining the rationale for ruling out non-cancer causes, adopting an 'open-door' policy for patients whose symptoms persist, considering abdominal ultrasound scans and introducing educational sessions for GPs about ovarian cancer symptomatology.
authors.affiliation: DIPEx, Department of Primary Health Care, University of Oxford, Old Road Campus, Oxford OX3 7LF, UK. julie.evans@dphpc.ox.ac.uk
authors.forename: Julie
authors.initials: J
authors.lastname: Evans
authors.forename: Sue
authors.initials: S
authors.lastname: Ziebland
authors.forename: Ann
authors.initials: A
authors.lastname: McPherson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001071:Appointments and Schedules; D003266:Continuity of Patient Care; D005194:Family Practice / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000401:mortality; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012017:Referral and Consultation; D016019:Survival Analysis; D013997:Time Factors; D006113:United Kingdom