Open Access Open Badges Research article

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

Peter W Rose1*, Willie Hamilton2, Kate Aldersey3, Andriana Barisic4, Martin Dawes5, Catherine Foot6, Eva Grunfeld78, Nigel Hart9, Richard D Neal10, Marie Pirotta11, Jeffrey Sisler12, Hans Thulesius13, Peter Vedsted14, Jane Young15, Greg Rubin16 and The ICBP Module 3 Working Group*

Author Affiliations

1 Department of Primary Care Health Sciences, New Radcliffe House, 2nd Floor, Radcliffe Observatory Quarter, University of Oxford, Woodstock Road, Oxford OX2 6GG, UK

2 University of Exeter Medical School, College House, St Luke’s Campus, Magdalen Road, Exeter EX1 2LU, UK

3 ICBP Programme, Cancer Research UK, Angel Building, 407 St John Street, London EC1V 4AD, UK

4 Department of Prevention and Cancer Control, Cancer Care Ontario, 620 University Avenue, Toronto, ON M5G 2L7, Canada

5 Department of Family Practice, David Strangway Building, University of British Columbia, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada

6 The King’s Fund, 11–13 Cavendish Square, London W1G 0AN, UK

7 Knowledge Translation Research Network Health Services Research Program, Ontario Institute for Cancer Research, Toronto, ON, Canada

8 Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON M5G 1V7, Canada

9 School of Medicine, Dentistry and Biomedical Sciences - Centre for Public Health, Queen’s University Belfast 2013, University Road, Belfast BT7 1NN, UK

10 Primary Care Medicine, North Wales Centre for Primary Care Research, Bangor University, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham LL13 7YP, UK

11 Primary Health Care Research Evaluation and Development, Department of General Practice, 200 Berkeley Street, Carlton, Victoria 3053, Australia

12 Division of Continuing Professional Development, Department of Family Medicine, University of Manitoba, 727 McDermot Avenue, Winnipeg, Manitoba R3E 3P5, Canada

13 Lund University, Box 117, SE-221 00 Lund, Sweden

14 Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark

15 Cancer Epidemiology, Public Health, School of Public Health, D02-QE11 Research Institute for Mothers and Infants, The University of Sydney, Sydney 2006, Australia

16 Wolfson Research Institute, Queen’s Campus, Durham University, Stockton on Tees TS17 6BH, UK

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BMC Family Practice 2014, 15:122  doi:10.1186/1471-2296-15-122

Published: 17 June 2014



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.

Survey; Primary care; Cancer; Diagnosis; International