There is increasing evidence that the time from first presentation of cancer to diagnosis is associated with prognosis. The aim of Module 3 was to kinase inhibitor Ivacaftor identify differences in primary care systems, structure or clinical practice that might contribute to known differences in cancer outcomes between ICBP jurisdictions. Specifically this related to factors that might influence delay in diagnosis or referral within primary care. Such factors can be 1 structural, such as access to investigations, access to specialist advice, 2 organisational, such as degree of gatekeeping and safety netting practices, and 3 knowledge and skills, such as the awareness of cancer symptoms and diagnostic skills among primary care practitioners.

In order to undertake such a study, we needed a valid and reliable measure of the differences in awareness, skills, structure and organisation between Inhibitors,Modulators,Libraries different primary care settings. The aim of this paper is to present the development of this measurement tool and the challenges that had to be addressed in the design and conduct of a survey of ICBP jurisdictions. The eleven jurisdictions, located in six countries, were England, Northern Ireland, Wales, Denmark, Norway, Sweden, British Columbia, Manitoba, Ontario, New South Wales and Victoria. Each jurisdiction contributed to the costs of the project and necessary ethical approvals. Methods Conceptualisation A group of primary care practitioners with expertise of cancer diagnosis, Inhibitors,Modulators,Libraries drawing on input from a review of literature, clinical experience and advice from a group of three international experts in the field, identified features and aspects of primary care systems, organisation and clinical practice which could contribute to international differences in the diagnosis of cancer.

From this a set of hypotheses was generated for testing. Features of primary care practice which were hypothesised as being influential Inhibitors,Modulators,Libraries included health system factors, diagnostic factors and referral factors as well as factors related to PCP behaviours, attitudes, skills, knowledge, Inhibitors,Modulators,Libraries practice administration and incentives. Initially, screening was also included but was then removed as the primary aim Inhibitors,Modulators,Libraries was in explaining differences in symptomatic diagnosis. The process was iterative, starting with all factors that could be relevant and then reducing these based on perceived importance, relevance to all jurisdictions, and feasibility for testing in a survey format. Decisions were made on a consensus basis until there was agreement on the form, structure and content of the survey to fully investigate the hypothesis. Teleconferences were scheduled at regular intervals and active email communication conducted to facilitate selleck decision making at all stages of the study.