and specific clinical, educational and organisational aspects. We chose to focus on the features related to the individual PCP and their activity in relation to cancer diagnosis. As an international collaboration ethics selleckbio approval was sought as required in each jurisdiction. To capture the differences in the generic aspects of health care systems, the ICBP Programme Board commissioned a comparative analysis of health care systems to contextualise the results of this study. This system mapping exercise represents a comparison of the health care systems found in each jurisdiction relating to cancer diagnosis, is been reported elsewhere. Key hypotheses of causes of delays to cancer diagnosis in primary care To ensure content validity was present for all jurisdictions, all features were discussed iteratively.

Recognising that long surveys affect response and completion rates, consensus was reached between the collaborators on the features considered to be the most important. Choice of data collection method A number of methodologies were considered including a questionnaire survey, system mapping, primary care notes review, simulated cases, qualitative interviews or focus groups with PCPs. We Inhibitors,Modulators,Libraries opted for survey methodology delivered electronically, as the most easily reproducible in several countries and languages, the easiest in which to maintain consistency between countries and its reasonable cost, whilst accessing the views of a larger number of PCPs. Operationalisation and development of survey The survey was developed in two parts.

The first part consisted of five clinical Inhibitors,Modulators,Libraries vignettes to capture the aspects of recognition of low risk but not no risk symptoms, delay in instigating investigations and reluctance to consider an alternative Inhibitors,Modulators,Libraries diagnosis. Vignettes are recognised to produce a better assessment of quality of care compared to record audit and they are faster to perform and more economical. Vignettes also predict physician performance as judged against consultations with trained actors and can be a good measure of process of care. They have also been validated in electronic form and used to measure care across different health systems in California. The vignettes were based on common clinical presentations of possible lung, colorectal and ovarian cancers. They were evidence based, using primary care evidence on symptoms sign and positive predictive values.

Breast cancer was omitted as we considered it very likely all women with a breast lump would be Inhibitors,Modulators,Libraries investigated, and there is very little Inhibitors,Modulators,Libraries sellekchem primary care evidence to support investigation non investigation of other breast symptoms. Each vignette was presented in two or three phases. with the second and third phase of each vignette representing a further presentation of the patient with additional symptoms or worsening severity of initial symptoms.