General Practice and Primary Care - Research Publications

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Author: Emery, Jonathan × Author: Saunders, Christobel × Author: Walter, Fiona × End date: 2019 × Start date: 2010 ×

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    The Improving Rural Cancer Outcomes Trial: a cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural cancer patients in Western Australia (vol 117, pg 1459, 2017)
    Emery, JD ; Gray, V ; Walter, FM ; Cheetham, S ; Croager, EJ ; Slevin, T ; Saunders, C ; Threlfall, T ; Auret, K ; Nowak, AK ; Geelhoed, E ; Bulsara, M ; Holman, CDJ (NATURE PUBLISHING GROUP, 2018-03-20)
    This corrects the article DOI: 10.1038/bjc.2017.310.
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    Diagnosing cancer in the bush: a mixed methods study of GP and specialist diagnostic intervals in rural Western Australia
    Emery, JD ; Walter, FM ; Gray, V ; Sinclair, C ; Howting, D ; Bulsara, M ; Bulsara, C ; Webster, A ; Auret, K ; Saunders, C ; Nowak, A ; Holman, D (OXFORD UNIV PRESS, 2013-10)
    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.
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    The Improving Rural Cancer Outcomes (IRCO) Trial: a factorial cluster-randomised controlled trial of a complex intervention to reduce time to diagnosis in rural patients with cancer in Western Australia: a study protocol
    Emery, JD ; Gray, V ; Walter, FM ; Cheetham, S ; Croager, EJ ; Slevin, T ; Saunders, C ; Threlfall, T ; Auret, K ; Nowak, AK ; Geelhoed, E ; Bulsara, M ; Holman, CDJ (BMJ PUBLISHING GROUP, 2014)
    INTRODUCTION: While overall survival for most common cancers in Australia is improving, the rural-urban differential has been widening, with significant excess deaths due to lung, colorectal, breast and prostate cancer in regional Australia. Internationally a major focus on understanding variations in cancer outcomes has been later presentation to healthcare and later diagnosis. Approaches to reducing time to diagnosis of symptomatic cancer include public symptom awareness campaigns and interventions in primary care to improve early cancer detection. This paper reports the protocol of a factorial cluster-randomised trial of community and general practice (GP) level interventions to reduce the time to diagnosis of cancer in rural Western Australia (WA). METHODS AND ANALYSIS: The community intervention is a symptom awareness campaign tailored for rural Australians delivered through a community engagement model. The GP intervention includes a resource card with symptom risk assessment charts and local referral pathways implemented through multiple academic detailing visits and case studies. Participants are eligible if recently diagnosed with breast, colorectal, lung or prostate cancer who reside in specific regions of rural WA with a planned sample size of 1350. The primary outcome is the Total Diagnostic Interval, defined as the duration from first symptom (or date of cancer screening test) to cancer diagnosis. Secondary outcomes include cancer stage, healthcare utilisation, disease-free status, survival at 2 and 5 years and cost-effectiveness. ETHICS AND DISSEMINATION: Ethics approval has been granted by the University of Western Australia and from all relevant hospital recruitment sites in WA. RESULTS: Results of this trial will be reported in peer-reviewed publications and in conference presentations. TRIAL REGISTRATION NUMBER: Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12610000872033.