Possible missed opportunities for diagnosing colorectal cancer in Dutch primary care: a multimethods approach.

07 Feb 2018

Background Early detection of colorectal cancer (CRC) is important to achieve better survival. Discriminating symptoms suggestive of colorectal cancer from benign conditions is a challenge for general practitioners since most known ‘alarm symptoms’ have low predictive values. Aim To further understand the diagnostic process in general practice in terms of health care use and by analysing factors related to diagnostic intervals. Design and setting A multi-methods approach comprising a historical prospective registry study and qualitative content analysis. Method Health care use in the year before referral for colonoscopy was compared between patients diagnosed with colorectal cancer and an age-, gender-, and GP-matched control population. Qualitative content analysis was performed on free texts in electronic patient records from a purposive sample of CRC patients. Results CRC Patients had 41% (25-29%) more face-to-face contacts and 21% (7-37%) more medication prescriptions than controls. Forty-six percent of CRC patients had 2 or more contacts for digestive reasons, compared to 12.2% of controls. From qualitative analysis two themes emerged; “possible missed diagnostic opportunities” and “improvements in diagnostic process unlikely”. Possible missed diagnostic opportunities were related to patients waiting before presenting symptoms, doctors attributing symptoms to co-morbid conditions or medication use, or doctors sticking to an initial diagnoses. Conclusion Less missed diagnostic opportunities might occur if GPs are aware of pitfalls in diagnosing CRC: the assumption that symptoms are caused by comorbid conditions or medication, or relating complaints to pre-existing medical conditions. GPs also need to be aware that repeated digestive complaints warrants rethinking earlier diagnoses.