title: Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions.
abstract: BACKGROUND
  Survival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer - the 'threshold' risk level at which they investigate or refer to a specialist for consideration of possible cancer - and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis.
  
  
  METHODS
  The work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature.A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English.
  
  
  RESULTS
  This work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems.
  
  
  CONCLUSIONS
  The vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries.
authors.affiliation: Department of Primary Care Health Sciences, New Radcliffe House, 2nd Floor, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK. peter.rose@phc.ox.ac.uk.
authors.forename: Peter W
authors.initials: PW
authors.lastname: Rose
authors.forename: Willie
authors.initials: W
authors.lastname: Hamilton
authors.forename: Kate
authors.initials: K
authors.lastname: Aldersey
authors.forename: Andriana
authors.initials: A
authors.lastname: Barisic
authors.forename: Martin
authors.initials: M
authors.lastname: Dawes
authors.forename: Catherine
authors.initials: C
authors.lastname: Foot
authors.forename: Eva
authors.initials: E
authors.lastname: Grunfeld
authors.forename: Nigel
authors.initials: N
authors.lastname: Hart
authors.forename: Richard D
authors.initials: RD
authors.lastname: Neal
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Sisler
authors.forename: Hans
authors.initials: H
authors.lastname: Thulesius
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
authors.forename: Jane
authors.initials: J
authors.lastname: Young
authors.forename: Greg
authors.initials: G
authors.lastname: Rubin
mesh_terms: D001315:Australia; D002170:Canada; D003718:Denmark; D004739:England; D006801:Humans; D009369:Neoplasms / Q000175:diagnosis*; D009664:Norway; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000592:standards*; D011795:Surveys and Questionnaires; D013548:Sweden; D014175:Translating