title: Factors influencing delay in the diagnosis of colorectal cancer: a study protocol.
abstract: BACKGROUND
  Colorectal cancer (CRC) is the second most frequent tumor in developed countries. Since survival from CRC depends mostly on disease stage at the time of diagnosis, individuals with symptoms or signs suspicious of CRC should be examined without delay. Many factors, however, intervene between symptom onset and diagnosis. This study was designed to: 1) Describe the diagnostic process of CRC from the onset of first symptoms to diagnosis and treatment. 2) Establish the time interval from initial symptoms to diagnosis and treatment, globally and considering patient's and doctors' delay, with the latter due to family physician and/or hospital services. 3) Identify the factors related to defined types of delay. 4) Assess the concordance between information included in primary health care and hospital clinical records regarding onset of first symptoms.
  
  
  METHODS
  Descriptive study, coordinated, with 5 participant groups of 5 different Spanish regions (Balearic Islands, Galicia, Catalunya, Aragon and Valencia Health Districts), with a total of 8 acute public hospitals and 140 primary care centers. Incident cases of CRC during the study period, as identified from pathology services at the involved hospitals. A sample size of 896 subjects has been estimated, 150 subjects for each participant group. Information will be collected through patient interviews and primary health care and hospital clinical records. Patient variables will include sociodemographic variables, family history of cancer, symptom perception, and confidence in the family physician; tumor variables will include tumor site, histological type, grade and stage; symptom variables will include date of onset, type and number of symptoms; health system variables will include number of patient contacts with family physician, type and content of the referral, hospital services attending the patient, diagnostic modalities and results; and delay intervals, including global delays and delays attributed to the patient, family physician and hospital.
  
  
  CONCLUSIONS
  To obtain a nonrestricted sample of patients with CRC we have minimized selection risk by identifying the patients from pathology services. A greater constraint may be associated with information sources based on clinical records. Due to inherent features of coordinated studies, it is important to standardize the collection of information.
authors: Primary Health Care Research Unit, Primary Health Care Mallorca District, Balearic Health Service, Reina Esclaramunda 9, Palma de Mallorca, Spain. mesteva@ibsalut.caib.es <mesteva@ibsalut.caib.es>
authors: Magdalena
authors: M
authors: Esteva
authors: Maria
authors: M
authors: Ramos
authors: Elena
authors: E
authors: Cabeza
authors: Joan
authors: J
authors: Llobera
authors: Amador
authors: A
authors: Ruiz
authors: Salvador
authors: S
authors: Pita
authors: Josep M
authors: JM
authors: Segura
authors: Jose M
authors: JM
authors: Cortes
authors: Luis
authors: L
authors: Gonzalez-Lujan
mesh_terms: D001294:Attitude to Health; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000401:mortality; D015981:Epidemiologic Factors; D006747:Hospital Communication Systems; D006801:Humans; D007407:Interviews as Topic; D010819:Physician's Role; D010821:Physicians, Family; D011787:Quality of Health Care; D012017:Referral and Consultation; D013997:Time Factors; D017748:Time Management
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