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      The Aarhus statement: improving design and reporting of studies on early cancer diagnosis

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          Abstract

          Early diagnosis is a key factor in improving the outcomes of cancer patients. A greater understanding of the pre-diagnostic patient pathways is vital yet, at present, research in this field lacks consistent definitions and methods. As a consequence much early diagnosis research is difficult to interpret. A consensus group was formed with the aim of producing guidance and a checklist for early cancer-diagnosis researchers. A consensus conference approach combined with nominal group techniques was used. The work was supported by a systematic review of early diagnosis literature, focussing on existing instruments used to measure time points and intervals in early cancer-diagnosis research. A series of recommendations for definitions and methodological approaches is presented. This is complemented by a checklist that early diagnosis researchers can use when designing and conducting studies in this field. The Aarhus checklist is a resource for early cancer-diagnosis research that should promote greater precision and transparency in both definitions and methods. Further work will examine whether the checklist can be readily adopted by researchers, and feedback on the guidance will be used in future updates.

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          Most cited references15

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          Consensus development methods: a review of best practice in creating clinical guidelines.

          Although there is debate about the appropriate place of guidelines in clinical practice, guidelines can be seen as one way of assisting clinicians in decision-making. Given the likely diversity of opinion that any group of people may display when considering a topic, methods are needed for organising subjective judgements. Three principal methods (Delphi, nominal group technique, consensus development conference) exist which share the common objective of synthesising judgements when a state of uncertainty exists. To identify the factors that shape and influence the clinical guidelines that emerge from consensus development methods and to make recommendations about best practice in the use of such methods. Five electronic databases were searched: Medline (1966-1996), PsychLIT (1974-1996), Social Science Citation Index (1990-1996), ABI Inform and Sociofile. From the searches and reference lists of articles a total of 177 empirical and review articles were selected for review. The output from consensus development methods may be affected by: the way the task is set (choice of cues, recognition of contextual cues, the focus of the task, the comprehensiveness of the scenarios); the selection of participants (choice of individuals, degree of homogeneity of the group, their background, their number); the selection and presentation of scientific information (format, extent to which its quality and content is assessed); the way any interaction is structured (number of rating rounds, ensuring equitable participation, physical environment for meetings); and the method of synthesising individual judgements (definition of agreement, rules governing outliers, method of mathematical aggregation). Although a considerable amount of research has been carried out, many aspects have not been investigated sufficiently. For the time being at least, advice on those aspects has, therefore, to be based on the user's own commonsense and the experience of those who have used or participated in these methods. Even in the long term, some aspects will not be amenable to scientific study. Meanwhile, adherence to best practice will enhance the validity, reliability and impact of the clinical guidelines produced.
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            Delay in diagnosis: the experience in Denmark

            Background: Denmark has poorer 5-year survival rates than many other Western European countries, and cancer patients tend to have more advanced stages at diagnosis than those in other Scandinavian countries. Part of this may be due to delay in diagnosis. The aim of this paper is to give an overview of the initiatives currently underway to reduce delays. Methods: Description of Danish actions to reduce delay. Results: Results of surveys of patient-, doctor- and system-related delays are presented and so are the political initiatives to ensure that cancer is seen as an acute disease. Conclusion: In future, fast-track diagnosis and treatment will be provided for suspected cancers and access to general diagnostic investigations will be improved. A large national experiment with cancer seen as an acute disease is currently being implemented, and as yet the results are unknown.
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              Do diagnostic delays in cancer matter?

              R Neal (2009)
              Background: The United Kingdom has poorer cancer outcomes than many other countries due partly to delays in diagnosing symptomatic cancer, leading to more advanced stage at diagnosis. Delays can occur at the level of patients, primary care, systems and secondary care. There is considerable potential for interventions to minimise delays and lead to earlier-stage diagnosis. Methods: Scoping review of the published studies, with a focus on methodological issues. Results: Trial data in this area are lacking and observational studies often show no association or negative ones. This review offers methodological explanations for these counter-intuitive findings. Conclusion: While diagnostic delays do matter, their importance is uncertain and must be determined through more sophisticated methods.
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                Author and article information

                Journal
                Br J Cancer
                Br. J. Cancer
                British Journal of Cancer
                Nature Publishing Group
                0007-0920
                1532-1827
                27 March 2012
                13 March 2012
                : 106
                : 7
                : 1262-1267
                Affiliations
                [1 ]Centre for Population Health Sciences, University of Edinburgh , Edinburgh, UK
                [2 ]Research Unit for General Practice, Aarhus University , Aarhus, UK
                [3 ]School of Medicine and Health, Durham University , Stockton-on-Tees, UK
                [4 ]General Practice and Primary Care Research Unit, University of Cambridge , Cambridge, UK
                [5 ]School of Primary, Aboriginal and Rural Health Care, University of Western Australia , Perth, Western Australia, Australia
                [6 ]Unit of Social and Behavioural Sciences, Dental Institute, King's College London , London, UK
                [7 ]Primary Care Diagnostics, Peninsula College of Medicine and Dentistry , Exeter, UK
                [8 ]Department of Primary Health Care, University of Oxford , Oxford, UK
                [9 ]North Wales Centre for Primary Care Research, Bangor University , Bangor, UK
                [10 ]University Medical College , St Radboud, Nijmegen, The Netherlands
                [11 ]Cancer Research UK , London, UK
                [12 ]Institute for General Practice, Johann Wolfgang Goethe University , Frankfurt, Germany
                Author notes
                Article
                bjc201268
                10.1038/bjc.2012.68
                3314787
                22415239
                2c691afb-849a-4a49-8a37-72b4c43a72f4
                Copyright © 2012 Cancer Research UK
                History
                : 08 November 2011
                : 13 January 2012
                : 14 February 2012
                Categories
                Guideline

                Oncology & Radiotherapy
                early diagnosis,methods,definitions,diagnostic intervals
                Oncology & Radiotherapy
                early diagnosis, methods, definitions, diagnostic intervals

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