Critical items for assessing risk of lung and colorectal cancer in primary care: a Delphi study

Br J Gen Pract. 2014 Aug;64(625):e509-15. doi: 10.3399/bjgp14X681001.


Background: Patients with lung or colorectal cancer often present late and have a poor prognosis. Identifying diagnostic indicators to optimally assess the risk of these cancers in primary care would support early identification and timely referral for patients at increased risk.

Aim: To obtain consensus regarding potential diagnostic indicators that are important for assessing the risk of lung or colorectal cancer in primary care consulters presenting with lung or abdominal symptoms.

Design and setting: A Delphi study was conducted with 28 participants from primary and secondary care and academic settings in the UK and Europe.

Method: Indicators were obtained from systematic reviews, recent primary studies and consultation with experts prior to the Delphi study being conducted. Over three rounds, participants rated each diagnostic indicator in terms of its importance, ranked them in order of importance, and rated each item as crucial or not crucial to assess during a GP consultation.

Results: The final round resulted in 25 items remaining for each type of cancer, including established cancer symptoms such as rectal bleeding for colorectal cancer and haemoptysis for lung cancer, but also less frequently used indicators such as patients' concerns about cancer.

Conclusion: This study highlights the items clinicians feel would be most crucial to include in the clinical assessment of primary care patients, a number of which have rarely been noted in the previous literature. Their importance in assessing the risk of lung or colorectal cancer will be tested as part of a large prospective cohort study (CANDID).

Keywords: Delphi technique; neoplasms; primary health care; referral and consultation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Clinical Protocols
  • Colorectal Neoplasms / diagnosis*
  • Colorectal Neoplasms / epidemiology
  • Delphi Technique
  • Early Detection of Cancer / methods*
  • Female
  • Humans
  • Lung Neoplasms / diagnosis*
  • Lung Neoplasms / epidemiology
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Primary Health Care / organization & administration*
  • Prognosis
  • Referral and Consultation / organization & administration*
  • Risk Assessment
  • United Kingdom / epidemiology