Table 3 Practitioner-associated delay factors

Bedikan et al (1979)

Texas, USA

Retrospective observational

73 patients (aged <40; 48% men, 52% women)

Stomach

Initial misdiagnosis

Moderate

Nagao and Takahashi (1979)

Japan

Retrospective observational

536 patients

Stomach

Initial misdiagnosis

Insufficient

MacAdam (1979)

England

Prospective observational

150 patients (21% with stomach cancer), 105 GPs

Stomach

Cancer site – stomach

Regular consulting rate of patient

Moderate

Ojala et al (1982)

Finland

Retrospective observational

162 patients (aged 38–82, mean 63; 59% men, 41% women)

Oesophagus

Initial misdiagnosis

Insufficient

Mikulin and Hardcastle (1987)

England

Prospective observational

83 patients (mean 71; 64% men, 36% women)

Stomach

Acid suppression treatment; patient age – younger

Patient age – older; patient social class – lower

Moderate

Zilling et al (1990)

Sweden

Prospective observational

50 patients (aged 31–85, mean 68; 74% men, 26% women)

Stomach

Patient sex – female; comorbidity; previously negative results

Patient sex – male

Strong

Hallissey et al (1990)

England

Cohort

2585 patients with dyspepsia (aged 40+)

Stomach

Initial misdiagnosis

Insufficient

Haugstvedt et al (1991)

Norway

Prospective observational

1165 patients

Stomach

Patient sex – female

Referral to university hospital

Moderate

Maglinte et al (1991)

Indiana, USA

Prospective observational

77 patients (aged 30–89, mean 59; 64% men, 36% women

Small intestine

Inappropriate tests

Moderate

Jones and Dudgeon (1992)

England

Retrospective observational

245 GPs, 1465 patients (>60 with upper GI cancer)

Oesophagus, stomach

Cancer site – oesophagus

Moderate

Arvanitakis et al (1992)

Greece

Observational

100 patients (aged 40–90; 64% men, 36% women)

Stomach

Initial misdiagnosis

Insufficient

Wile et al (1993)

California, USA

Retrospective observational

49 patients (median 57; 45% men, 55% women)

Stomach

Inaccurate tests

Strong

Martin et al (1997)

England

Prospective observational

115 patients (aged 31–89, median 66; 61% men, 39% women)

Oesophagus, stomach

Frequent attendance by patient; cancer site – oesophagus

Access to rapid screening (open access endoscopy)

Initial symptom

Insufficient

Rothwell et al (1997)

Ireland

Prospective observational

100 patients (aged 37–83, median 69; 70% men, 30% women)

Oesophagus

Acid suppression treatment; initial misdiagnosis; inappropriate tests

Moderate

Bramble et al (2000)

England

Retrospective observational

133 patients (aged 38–97, mean 69; 53% men, 47% women)

Oesophagus, stomach

Acid suppression treatment

Strong

Mariscal et al (2001)

Spain

Prospective observational

217 patients (aged 59–74, mean 65; 59% men, 41% women), 27% with upper GI cancer

Oesophagus, stomach

Comorbidity; symptom type – pain, bleeding

Strong

Irving et al (2002)

England

Observational

90 patients (72% with oesophageal, 28% with gastric)

Oesophagus, stomach

Use of referral guidelines; 2-week rule

Strong

Manes et al (2002)

Italy

Cross-sectional

706 endoscopy referrals (aged 15–86, mean 47; 55% men, 45% women)

Stomach

Inappropriate use of endoscopy^a

Strong

Look et al (2003)

Singapore

Retrospective observational

44 patients (aged 36–83, mean 67; 70% men, 30% women)

Stomach

Previously negative results

Moderate