title: Diagnosing cancer in the bush: a mixed methods study of GP and specialist diagnostic intervals in rural Western Australia.
abstract: BACKGROUND
  Previous studies have focused on the treatment received by rural cancer patients and have not examined their diagnostic pathways as reasons for poorer outcomes in rural Australia.
  
  
  OBJECTIVE
  To compare and explore diagnostic pathways and diagnostic intervals in patients with breast, lung, prostate or colorectal cancer from rural Western Australia (WA) to inform future interventions aimed at reducing time to cancer diagnosis.
  
  
  METHODS
  Mixed methods study of people recently diagnosed with breast, lung, prostate or colorectal cancer from the Goldfields and Great Southern Regions of WA. Qualitative interviews explored participants' diagnostic pathways and factors underlying differences observed between individuals and cancers. Data were extracted from general practice and hospital records to calculate intervals from first presentation in general practice to final diagnosis.
  
  
  RESULTS
  Sixty-six participants were recruited (43 Goldfields and 23 Great Southern region; 24 breast, 20 colorectal, 14 prostate and 8 lung cancers). There were significant overall differences between cancers in time from presentation in general practice to referral (P = 0.045), from referral to seeing a specialist (P = 0.010) and from specialist appointment to cancer diagnosis (P ≤ 0.001). These differences were due to the nature of presenting symptoms, access to diagnostic tests and multiple visits to specialists. Breast cancer was diagnosed more quickly because its symptoms are more specific and due to better access to diagnostic tests and specialist one-stop clinics.
  
  
  CONCLUSIONS
  Interventions to improve cancer diagnosis in rural Australia should focus on better case selection in general practice and better access to diagnostic tests, especially for prostate and colorectal cancers.
authors.affiliation: General Practice, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Australia.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
authors.forename: Fiona M
authors.initials: FM
authors.lastname: Walter
authors.forename: Vicky
authors.initials: V
authors.lastname: Gray
authors.forename: Craig
authors.initials: C
authors.lastname: Sinclair
authors.forename: Denise
authors.initials: D
authors.lastname: Howting
authors.forename: Max
authors.initials: M
authors.lastname: Bulsara
authors.forename: Caroline
authors.initials: C
authors.lastname: Bulsara
authors.forename: Andrew
authors.initials: A
authors.lastname: Webster
authors.forename: Kirsten
authors.initials: K
authors.lastname: Auret
authors.forename: Christobel
authors.initials: C
authors.lastname: Saunders
authors.forename: Anna
authors.initials: A
authors.lastname: Nowak
authors.forename: D'Arcy
authors.initials: D
authors.lastname: Holman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis; D015179:Colorectal Neoplasms / Q000175:diagnosis; D019091:Critical Pathways; D057210:Delayed Diagnosis; D005260:Female; D058006:General Practice; D006297:Health Services Accessibility; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D011471:Prostatic Neoplasms / Q000175:diagnosis; D019035:Rural Health Services; D013038:Specialization; D013997:Time Factors; D016896:Treatment Outcome; D014904:Western Australia
keywords: Breast cancer; colorectal cancer; lung cancer; primary care; prostate cancer; rural health