title: Quality deviations in cancer diagnosis: prevalence and time to diagnosis in general practice.
abstract: BACKGROUND
  High quality in every phase of cancer diagnosis is important to optimise the prognosis for the patient. General practice plays an important role in this phase.
  
  
  OBJECTIVE
  The aim was to describe the prevalence and the types of quality deviations (QDs) that arise during the diagnostic pathway in general practice as assessed by GPs and to analyse the association between these QDs, the cancer type, and the GP's interpretation of presenting symptoms as well as the influence on the diagnostic interval.
  
  
  METHODS
  A Danish retrospective cohort study based on questionnaire data from 1466 GPs on 5711 incident patients with cancer identified in the Danish National Patient Registry (response rate = 71.4%). The GP was involved in diagnosing in 4036 cases.
  
  
  METHODS
  Predefined QDs were prompted with the possibility for free text. QD prevalence was estimated as was the association between QDs and diagnosis, the GP's symptom interpretation, and time to diagnosis.
  
  
  RESULTS
  QDs were present for 30.4% (95% confidence interval [CI] = 29.0 to 31.9) of cancer patients. The most prevalent QD was 'retrospectively, one or more of my clinical decisions were less optimal'. QDs were most prevalent among patients with vague symptoms (24.1% for alarm symptoms versus 39.5% for vague symptoms [P<0.001]). QD presence implied a 41-day (95% CI = 38.4 to 43.6) longer median diagnostic interval.
  
  
  CONCLUSIONS
  GPs noted at least one QD, which often involved clinical decisions, for one-third of all cancer patients. QDs were more likely among patients with vague symptoms and increased the diagnostic interval considerably.
authors.affiliation: Research Unit for General Practice, Research Centre for Cancer Diagnosis in Primary Care, Health, Aarhus University, Aarhus, Denmark.
authors.forename: Henry
authors.initials: H
authors.lastname: Jensen
authors.forename: Aase
authors.initials: A
authors.lastname: Nissen
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D015331:Cohort Studies; D003625:Data Collection; D003627:Data Interpretation, Statistical; D057210:Delayed Diagnosis / Q000517:prevention & control* / Q000706:statistics & numerical data; D003718:Denmark / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D058006:General Practice / Q000592:standards; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D010818:Practice Patterns, Physicians' / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D011379:Prognosis; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012017:Referral and Consultation / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D011795:Surveys and Questionnaires
keywords: delayed diagnosis; general practice; healthcare; neoplasms; quality assessment, risk management