Siewers, I.M. (2017) Diagnostisch proces colorectaal carcinoom in de huisartsenpraktijk: een mixed methods onderzoek. thesis, Medicine.
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Abstract
Introduction and aim: The results of a recent study tell us that the primary healthcare use of patients with colorectal carcinoma (CRC) is raised in the year before diagnosis in comparison with patients without cancer. Known is that a low stage CRC is associated with a good prognosis and therefore a good and early diagnosis is important.To reach an early diagnosis,knowledge is needed about the behavior of patients around help seeking in healthcare and visiting the general practitioner in the year before diagnosis. We aim to draw a more complete picture of the diagnostic process of CRC in general practice. Methods: A mixed methods approach (combination of quantitative and qualitative data) was applied to study health care use and the diagnostics process in general practice. Data about healthcare use was collected from database of the Registration Network Groningen (RNG). The quantitative part analyzed face-to-face contacts and medication use at CRC patients in the year before diagnosis and this is compared with the control group in a historic prospective study.The qualitative analysis is based on a qualitative content analysis which used data from the electronic health record system from patients selected on age, gender, GP, tumor location, tumor stage and number of GP-contacts in the year preceding diagnosis. A thematic analysis based on an iterative process is used until saturation was reached. Results: The quantitative analysis included 287 patients matched with 828 controls. In the year before diagnosis CRC patients have 41% more face-to-face contacts with the general practitioner and use 12% (1.07 1.37) more medication then controls. CRC patients showed significantly more contacts coded as general and unspecified reasons , digestive system , musculoskeletal, respiratory , and endocrine, metabolic, and nutritional reasons in the year prior to diagnosis, compared to controls. For the quantitative analysis are 57 patients included. Three final themes emerged, two about the improvement of the diagnostic process of CRC and one about de complaints CRC patients come with. Conclusion: Within the diagnostic process of CRC is in some cases improvement possible. This improvement may have to do with delays- related to patient factors as well as healthcare related factors. In addition to the well-known alarm symptoms we see a range of vague symptoms like abdominal sounds and back problems. Important is that general practitioners keep thinking and not always hold on the working diagnosis. Although the complaints from CRC patients are not always specific, it is important to keep a possible diagnosis CRC in mind.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Facultair begeleiders: and Brandenbarg, Drs. D. and Berendsen, Dr. A.J. and Afdeling huisartsgeneeskunde, oncologie in de eerste lijn |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:46 |
| Last Modified: | 25 Jun 2020 10:46 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/715 |
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