title: Factors influencing the speed of cancer diagnosis in rural Western Australia: a General Practice perspective.
abstract: BACKGROUND
  The speed of diagnosis impacts on prognosis and survival in all types of cancer. In most cases survival and prognosis are significantly worse in rural and remote Australian populations who have less access to diagnostic and therapeutic services than metropolitan communities in this country. Research suggests that in general delays in diagnosis were a factor of misdiagnosis, the confounding effect of existing conditions and delayed or misleading investigation of symptoms. The aim of this study is to further explore the factors that impact on the speed of diagnosis in rural Western Australia with direct reference to General Practitioners (GPs) working in this setting.
  
  
  METHODS
  The methodology consisted of a structured discussion of specific cases. GPs based in two rural locations in Western Australia were asked to identify up to eight clinical cases for discussion. A diversity of cases was requested encompassing those with timely and delayed diagnosis of cancer. Focus groups were held with the practitioners to identify which factors under six headings delayed or facilitated the diagnosis in each case. A structured summary of the discussion was relayed to a wider group of GPs to seek additional views or comments on specific factors that impact on the speed of cancer diagnosis in rural and remote locations in Australia.
  
  
  RESULTS
  A number of factors affecting the speed of diagnosis were identified: the demographic shift towards a frailer and older population, presenting with multiple and complex diseases, increases the challenge to identify early cancer symptoms; seasonal and demanding work patterns leading to procrastination in presenting for medical care; unhelpful scheduling of specialist appointments; and the varying impact of informal networks and social relationships.
  
  
  CONCLUSIONS
  Within the limitations of this study we have generated a number of hypotheses that require formal evaluation: (1) GPs working within informal professional and social networks are better informed about their patients' health needs and have an advantage in making early diagnosis; (2) Despite the other differences in the population characteristics decentralising services would improve the prospect for timely diagnosis; and (3) Careful coordination of specialist appointments would improve the speed of diagnosis for rural patients.
authors.affiliation: Western Australian Centre for Cancer and Palliative Care, Curtin University of Technology, Perth, Western Australia. m.jiwa@curtin.edu.au
authors.forename: Moyez
authors.initials: M
authors.lastname: Jiwa
authors.forename: Georgia
authors.initials: G
authors.lastname: Halkett
authors.forename: Samar
authors.initials: S
authors.lastname: Aoun
authors.forename: Hayley
authors.initials: H
authors.lastname: Arnet
authors.forename: Marthe
authors.initials: M
authors.lastname: Smith
authors.forename: Megan
authors.initials: M
authors.lastname: Pilkington
authors.forename: Cheryl
authors.initials: C
authors.lastname: McMullen
mesh_terms: D005194:Family Practice / Q000706:statistics & numerical data*; D017144:Focus Groups; D019983:Guideline Adherence / Q000706:statistics & numerical data; D019538:Health Care Surveys; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D008511:Medicine / Q000706:statistics & numerical data; D009369:Neoplasms / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000706:statistics & numerical data; D019035:Rural Health Services / Q000706:statistics & numerical data*; D012944:Social Support; D013038:Specialization; D014904:Western Australia