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01.12.2014 | Research article | Ausgabe 1/2014 Open Access

BMC Family Practice 1/2014

Development of a survey instrument to investigate the primary care factors related to differences in cancer diagnosis between international jurisdictions

BMC Family Practice > Ausgabe 1/2014
Peter W Rose, Willie Hamilton, Kate Aldersey, Andriana Barisic, Martin Dawes, Catherine Foot, Eva Grunfeld, Nigel Hart, Richard D Neal, Marie Pirotta, Jeffrey Sisler, Hans Thulesius, Peter Vedsted, Jane Young, Greg Rubin, The ICBP Module 3 Working Group*
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2296-15-122) contains supplementary material, which is available to authorized users.

Competing interests

WH is the clinical lead for the ongoing revision of the NICE 2005 guidance on referral for suspected cancer, CG27. His contribution to this article is in a personal capacity, and is not to be interpreted as representing the view of the Guideline Development Group, or of NICE itself. The other authors declare that they have no competing interests.

Authors’ contributions

The initial development of the survey in England was undertaken by PWR, WH, CG with support from CF. KA undertook the validation in England. All authors contributed to the development of the initial survey into an international instrument. PWR wrote the original manuscript with subsequent contributions from all authors. PWR, WH, KA, AB, MD, CF, EG, NH, RDN, MP, JS, HT, PV, JY and GR were responsible for ensuring the language and terminology of the survey was relevant to their health economy. PWR, WH, KA, AB, MD, CF, EG, NH, RDN, MP, JS, HT, PV, JY and GR contributed to, reviewed and approved the final manuscript. PV, HT, SSA were responsible for translation into the Scandinavian languages and validation in these countries.



Survival rates following a diagnosis of cancer vary between countries. The International Cancer Benchmarking Partnership (ICBP), a collaboration between six countries with primary care led health services, was set up in 2009 to investigate the causes of these differences. Module 3 of this collaboration hypothesised that an association exists between the readiness of primary care physicians (PCP) to investigate for cancer – the ‘threshold’ risk level at which they investigate or refer to a specialist for consideration of possible cancer – and survival for that cancer (lung, colorectal and ovarian). We describe the development of an international survey instrument to test this hypothesis.


The work was led by an academic steering group in England. They agreed that an online survey was the most pragmatic way of identifying differences between the jurisdictions. Research questions were identified through clinical experience and expert knowledge of the relevant literature.
A survey comprising a set of direct questions and five clinical scenarios was developed to investigate the hypothesis. The survey content was discussed and refined concurrently and repeatedly with international partners. The survey was validated using an iterative process in England. Following validation the survey was adapted to be relevant to the health systems operating in other jurisdictions and translated into Danish, Norwegian and Swedish, and into Canadian and Australian English.


This work has produced a survey with face, content and cross cultural validity that will be circulated in all six countries. It could also form a benchmark for similar surveys in countries with similar health care systems.


The vignettes could also be used as educational resources. This study is likely to impact on healthcare policy and practice in participating countries.
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