title: Advice to consult a general medical practitioner in Western Australia: could it be cancer?
abstract: BACKGROUND
  Many people will consult a medical practitioner about lower bowel symptoms, and the demand for access to general practitioners (GPs) is growing. We do not know if people recognise the symptoms of lower bowel cancer when advising others about the need to consult a doctor. A structured vignette survey was conducted in Western Australia.
  
  
  METHODS
  Participants were recruited from the waiting rooms at five general practices. Respondents were invited to complete self-administered questionnaires containing nine vignettes chosen at random from a pool of 64 based on six clinical variables. Twenty-seven vignettes described high-risk bowel cancer scenarios. Respondents were asked if they would recommend a medical consultation for the case described and whether they believed the scenario was a cancer presentation. Logistic regression was used to estimate the independent effects of each variable on the respondent's judgement. Two-hundred and sixty-eight completed responses were collected over eight weeks.
  
  
  RESULTS
  The majority (61%) of respondents were female, aged 40 years and older. A history of rectal bleeding, six weeks of symptoms, and weight loss independently increased the odds of recommending a consultation with a medical practitioner by a factor of 7.64, 4.11 and 1.86, respectively. Most cases that were identified as cancer (75.2%) would not be classified as such on current research evidence. Factors that predict recognition of cancer presentations include rectal bleeding, weight loss and diarrhoea.
  
  
  CONCLUSIONS
  Within the limitation of this study, respondents recommended that most symptomatic people present to their GP. However, we report no evidence that they recognised a cancer presentation, and duration of symptoms was not a significant variable in this regard. Cases that were identified as 'cancer' could not be classified as high risk on the available evidence.
authors.affiliation: Western Australian Centre for Cancer and Palliative Care, Curtin Health Innovation Research Institute, Curtin University of Technology, Perth, 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: Hayley
authors.initials: H
authors.lastname: Arnet
authors.forename: Marthe
authors.initials: M
authors.lastname: Smith
authors.forename: Ruth
authors.initials: R
authors.lastname: McConigley
authors.forename: David
authors.initials: D
authors.lastname: Lim
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
authors.forename: Akil
authors.initials: A
authors.lastname: Islam
mesh_terms: D000328:Adult; D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003657:Decision Making; D005194:Family Practice; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D010819:Physician's Role; D012017:Referral and Consultation; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D014904:Western Australia