title: Interventions to reduce primary care delay in cancer referral: a systematic review.
abstract: BACKGROUND
  Reducing delay in the primary care part of the cancer care pathway is likely to improve cancer survival. Identifying effective interventions in primary care would allow action by primary healthcare professionals and local commissioners to reduce delay.
  
  
  OBJECTIVE
  To identify interventions that reduce primary care delay in the referral of patients with cancer to secondary care.
  
  
  METHODS
  Systematic review in primary care.
  
  
  METHODS
  Eight electronic databases were searched using terms for primary  care, cancer, and delay. Exclusion criteria included screening and the 2-week-wait referral system. Reference lists of relevant papers were hand searched. The quality of each paper was assessed using predefined criteria, and checked by a second reviewer.
  
  
  RESULTS
  Searches  identified 1798 references, of which 22 papers were found to meet the criteria. Interventions concerning education, audit and feedback, decision support software and guideline use, diagnostic tools, and other specific skills training were identified. Most studies reported a positive effect  on their specified outcomes, although no study measured a direct effect on reducing delay.
  
  
  CONCLUSIONS
  There was no evidence that any intervention directly reduced primary care delay in the diagnosis of cancer. Limited evidence suggests that complex interventions, including  audit and feedback and specific skills training, have the potential to do so.
authors.affiliation: Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire. g.mansell@cphc.keele.ac.uk
authors.forename: Gemma
authors.initials: G
authors.lastname: Mansell
authors.forename: Mark
authors.initials: M
authors.lastname: Shapley
authors.forename: Joanne L
authors.initials: JL
authors.lastname: Jordan
authors.forename: Kelvin
authors.initials: K
authors.lastname: Jordan
mesh_terms: D002983:Clinical Competence / Q000592:standards; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000592:standards*; D004503:Education, Medical, Graduate / Q000379:methods; D005246:Feedback; D058006:General Practice / Q000193:education / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D009369:Neoplasms / Q000175:diagnosis*; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation / Q000592:standards*