title: Agreement between patients and general practitioners on quality deviations during the cancer diagnostic pathway and associations with time to diagnosis.
abstract: BACKGROUND
  High quality and minimal delay are crucial and anticipated elements in the diagnostic cancer pathway as delay in the diagnosis may worsen the prognosis and cause lower patient satisfaction.
  
  
  OBJECTIVE
  The aim of this study was to describe agreement in reported quality deviations (QDs) between general practitioners (GPs) and cancer patients during the diagnostic pathway in primary care and to estimate the association between length of diagnostic interval and level of agreement on reported QDs.
  
  
  METHODS
  The study was carried out as a Danish cross-sectional study of incident cancer patients identified in the Danish National Patient Registry. Data were collected by independent questionnaires from patients (response rate: 53.0%) and their GPs (response rate: 73.8%), and 2177 pairs of questionnaires were subsequently combined. Agreement between GP- and patient-reported QDs was estimated using Cohen's Kappa, whereas the association between level of agreement and time to diagnosis was estimated using quantile regression.
  
  
  RESULTS
  Patients reported QDs in 29.0% and GPs in 28.5% of the cases, but agreed only slightly on QD presence (Kappas between -0.08 and 0.26). Agreement on 'QD presence' was associated with a 54-day (95%CI: 44-64) longer time to diagnosis than agreement on 'no QD presence'. The association with a longer diagnostic interval was stronger when only GP reported a QD the association than when only patient reported a QD.
  
  
  CONCLUSIONS
  Included GPs and patients agreed only slightly on QD presence although they reported the same amount of QDs; this suggests that GPs and patients see QDs as two different concepts. QD presence had a stronger impact on time to diagnosis when reported by the GP (alone or in agreement with the patient) than when reported by the patient alone. The GP may thus be the most important source of information on QD and diagnostic interval, while the patient information tends to underpin this assessment.
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health and Section for General Medical Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, DK-8000 Aarhus C and henry.jensen@feap.dk.
authors.forename: Henry
authors.initials: H
authors.lastname: Jensen
authors.affiliation: Documentation & Quality, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen OE, Denmark.
authors.forename: Cecilie
authors.initials: C
authors.lastname: Sperling
authors.affiliation: Documentation & Quality, Danish Cancer Society, Strandboulevarden 49, DK-2100 Copenhagen OE, Denmark.
authors.forename: Mette
authors.initials: M
authors.lastname: Sandager
authors.affiliation: Research Centre for Cancer Diagnosis in Primary Care, Research Unit for General Practice, Department of Public Health and.
authors.forename: Peter
authors.initials: P
authors.lastname: Vedsted
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis / Q000009:adverse effects / Q000706:statistics & numerical data*; D003718:Denmark; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000175:diagnosis*; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D011379:Prognosis; D011785:Quality Assurance, Health Care / Q000379:methods / Q000706:statistics & numerical data*; D011788:Quality of Life; D012042:Registries; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Agreement; Denmark; delayed diagnosis; general practice; health care quality assessment.; neoplasms