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

Jon Emery, Fiona Walter, Victoria Gray, Craig Sinclair, Denise Howting, M. Bulsara, Caroline Bulsara, A. Webster, Kirsten Auret, Christobel Saunders, Anna Nowak, D'Arcy Holman

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Abstract

Background. 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.
Objectives. 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.
Methods. 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.
Results. 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.
Conclusions. 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.
Keywords. Breast cancer, colorectal cancer, lung cancer, primary care, prostate cancer, rural
health.
Original languageEnglish
Pages (from-to)541-550
JournalFamily Practice
Volume30
Issue number5
Early online date22 May 2013
DOIs
Publication statusPublished - Oct 2013

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