Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer

Objective: To examine the influence of patient and physician communication factors on diagnostic delay (DD). Methods: 242 patients diagnosed with colorectal cancer (CRC) in the past 6 months who experienced symptoms prior to diagnosis were administered a 2-h semi-structured qualitative interview to assess communication with health care provider and ease of access to care, among other factors. Patient-provided information was verified via review of medical records. Results: The factors associated with DD > 2 months included lower income (OR = 0.56, p= 0.03), having regular physician prior to receiving a cancer diagnosis (OR = 2.52, p= 0.03), having a physician who used temporizing communication strategies during the consultation (OR = 2.41, p= 0.02), receiving an initial alternate diagnosis (OR = 3.36, p= 0.02), experiencing referral delay (OR = 3.61, p= < 0.001), and experiencing follow-up delay of any kind (OR = 3.32, p= 0.01). Conclusion: Excellent communication skills that appropriately probe for relevant social and economic patient information, assist patients in distinguishing and elaborating on symptoms, and provide clear rationale and instructions for future steps, will speed along the diagnosis process and could be the difference between early and late stage CRC. Practice implications: Increased understanding of physician communication and practice styles that contribute to DD could have a positive impact on decreasing the morbidity and mortality from this disease.