title: Critical items for assessing risk of lung and colorectal cancer in primary care: a Delphi study.
abstract: BACKGROUND
  Patients with lung or colorectal cancer often present late and have a poor prognosis. Identifying diagnostic indicators to optimally assess the risk of these cancers in primary care would support early identification and timely referral for patients at increased risk.
  
  
  OBJECTIVE
  To obtain consensus regarding potential diagnostic indicators that are important for assessing the risk of lung or colorectal cancer in primary care consulters presenting with lung or abdominal symptoms.
  
  
  METHODS
  A Delphi study was conducted with 28 participants from primary and secondary care and academic settings in the UK and Europe.
  
  
  METHODS
  Indicators were obtained from systematic reviews, recent primary studies and consultation with experts prior to the Delphi study being conducted. Over three rounds, participants rated each diagnostic indicator in terms of its importance, ranked them in order of importance, and rated each item as crucial or not crucial to assess during a GP consultation.
  
  
  RESULTS
  The final round resulted in 25 items remaining for each type of cancer, including established cancer symptoms such as rectal bleeding for colorectal cancer and haemoptysis for lung cancer, but also less frequently used indicators such as patients' concerns about cancer.
  
  
  CONCLUSIONS
  This study highlights the items clinicians feel would be most crucial to include in the clinical assessment of primary care patients, a number of which have rarely been noted in the previous literature. Their importance in assessing the risk of lung or colorectal cancer will be tested as part of a large prospective cohort study (CANDID).
authors: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele.
authors: Gemma
authors: G
authors: Mansell
authors: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele.
authors: Mark
authors: M
authors: Shapley
authors: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele.
authors: Danielle
authors: D
authors: van der Windt
authors: Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele.
authors: Tom
authors: T
authors: Sanders
authors: Primary Medical Care, Aldermoor Health Centre, Southampton.
authors: Paul
authors: P
authors: Little
mesh_terms: D000328:Adult; D002985:Clinical Protocols; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D003697:Delphi Technique; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011320:Primary Health Care / Q000458:organization & administration*; D011379:Prognosis; D012017:Referral and Consultation / Q000458:organization & administration*; D018570:Risk Assessment; D006113:United Kingdom / Q000453:epidemiology
keywords: Delphi technique; neoplasms; primary health care; referral and consultation