Background

Colorectal cancer (CRC) can be successfully treated when found early. Yet symptoms indicative of CRC are varied and easily mistaken for other health conditions. Physicians can easily misconstrue symptoms and thus delay diagnosis. This study examines why CRC diagnostic delay occurs.

Methods

Unannounced standardized patients (SPs) were introduced to primary care practices and met with physicians concerning gastrointestinal symptoms indicative of CRC. The consultations were audiorecorded and then coded using SCCAP.  The subsequently generated medical records were abstracted. Physicians were surveyed to assess whether the SP was detected; fewer than 2% have been. Practices were recruited from two US metropolitan areas.

Results

Of the 144 SPs seen, 21.5% (n=31) resulted in an appropriate diagnosis being discussed with the patient or noted in the medical record. In twice as many instances [44.4% (n = 64)] a plan to conduct appropriate testing occurred. Overall, half of all patient consultations resulted in either an appropriate diagnosis or plans to conduct appropriate diagnostic testing 52.8% (n = 76).  Male SPs were significantly more likely to receive the correct diagnosis/tests (X² = 7.49, p = 0.006) but African American (AA) females were most likely to receive incorrect diagnoses/tests (X² = 9.71, p = 0.021).  No physician characteristics were found to be associated with study outcomes.  Visits in which appropriate diagnoses/tests resulted were lengthier (Mean rank 80.54 vs. 63.51; p=0.14); spent less time asking questions (Mean rank 65.78 vs. 80.01; p=0.041) but more time discussing physical exam findings (Mean rank 80.10 vs. 64.01; p=0.021); were more likely to offer a referral  (p=0.080) and more time expressing emotions (e.g., concern/worry about symptoms) (mean rank=79.26 vs. 64.95; p=0.021).

Conclusions

Gender, race and the verbal tactics of the consultation were all significantly associated with appropriate diagnosis or diagnostic plan. AA women were most likely to be misdiagnosed.