Reasons for delay in presentation by patients with symptoms of cancer and influences on time to referral by practitioners are complex and multi-factorial according to the combined findings of two systematic reviews of the literature on common cancers.
Improved awareness, access to treatment and timely referrals by private practitioners are also required to reduce treatment delays.
That is, recommendations from family and friends, and even the employer or workplace, as well as direct referrals by general practitioners and other health professionals are critical in "introducing" a potential participant to the GHS.
For example, state reimbursement for radiographs may be limited to referrals by medical practitioners, even though others, such as physiotherapists or podiatrists, may be credentialed to order these diagnostic tests [ 43].
Delay can occur at three phases during the diagnostic process: first, in the interval between the patient first noticing a symptom and first consulting a doctor (often referred to as patient delay), second, between first consultation and referral by a practitioner (doctor or practitioner delay) and finally, between referral and diagnosis (hospital or system delay) (Nichols et al, 1981).
A large majority of patients could be included after direct referral by general practitioners.
The most likely explanations for this are either late presentation by patients or late onward referral by general practitioners.
When the present data were collected, access to ophthalmologists in France did not require referral by general practitioners.
Patients will be recruited by media (announcements, banners placed in various related websites, media attention in interviews), referral by general practitioners and mental health services.
Administrative staff, who were unconnected to the study were responsible for assigning patients to surgical teams at the point of referral by general practitioners.
We analysed drug prescription and referral by general practitioners anywhere during the episode, comparing these to the recommendations in the guideline on urinary tract infections developed by the Dutch College of General Practitioners [ 16].
