Diagnosing cancer in the bush: a mixed methods study of GP and specialist diagnostic intervals in rural Western Australia

J D Emery,A Nowak,C Bulsara,M Bulsara,C Saunders,D Holman,A Webster,D Howting,C Sinclair,F M Walter,V Gray,K Auret

doi:10.1093/fampra/cmt016

Abstract

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. 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. 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. 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. 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.

Highlights

Diagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration
Agreement was lower for more detailed coding (percentage agreement 35%; Kappa score of 0.3). It appears that implementation of diagnostic coding would be possible in the majority of the chiropractic practices that participated in this study
For those chiropractors who do not focus on symptoms in their approach to clinical care, it could be challenging to use the International Classification of Primary Care (ICPC)-2 PLUS coding system, since ICPC-2 PLUS is a symptom-based classification

Summary

Introduction

Diagnostic coding has several potential benefits, including improving the feasibility of data collection for research and clinical audits and providing a common language to improve interdisciplinary collaboration. The primary aim of this study was to determine the views and perspectives of chiropractors about diagnostic coding and explore the use of it in a chiropractic setting. Diagnostic coding in chiropractic practice has several potential benefits These benefits include improving the feasibility of data collection for research and clinical audits, improving the clinical applicability of research, and providing a common clinical language to help improve. The International Classification of Primary Care (ICPC) is an example of a diagnostic coding system that could be relevant for chiropractic practice [2]. A second version of the diagnostic code system, International Classification of Primary Care, Version 2 (ICPC-2), was published in 1998. ICPC has gradually received increasing recognition and use, especially in Europe and Australia [2]

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