Exploring colorectal cancer patients’ diagnostic pathways and general practitioners’ assessment of the diagnostic processes - a Danish survey study

Sep 22, 2026

Colorectal cancer (CRC) is highly common, and outcomes depend strongly on cancer stage at diagnosis. Although many cases are diagnosed quickly, delays remain, especially when symptom presentation is non-specific and primary care must decide whether to suspect cancer. A Danish survey study invited all general practitioners (GPs) in North-, Central-, and Southern Denmark to complete questionnaires for patients diagnosed with cancer in the preceding two years.

LanguageEnglish

CategoryResearch & Report

FormatPDF

Pages10

Reading Time25 min

AccessFree to download

Abstract

Introduction

Aim

Methods

Results

Conclusion

Introduction

Role of general practitioners in diagnostic processes

Scandinavian Journal of Primary HealtH care 2025, vol. 43, no. 2, 303–312 [https://doi.org/10.1080/02813432.2024.2432376](https://doi.org/10.1080/02813432.2024.2432376) ReseaRch aRticle Exploring colorectal cancer patients’ diagnostic pathways and general practitioners’ assessment of the diagnostic processes: a Danish survey study Dorte e. Jarbøla , sanne Rasmussena, Kirubakaran Balasubramaniama , Jesper lykkegaarda,b , linda Juel ahrenfeldta , Gitte B. lauridsena and Peter haastrupa adepartment of Public Health, research unit of General Practice, university of Southern denmark, odense m, denmark; baudit Project odense, research unit of General Practice, university of Southern denmark, odense m, denmark ABSTRACT Introduction: colorectal cancer (cRc) is among the most common cancers and the prognosis ofcRc is highly dependent on stage at diagnosis. although many cases are diagnosed swiftly, thereis still room for improvement. Aim: We aimed to explore cRc diagnostic pathways, encompassing (1) place of initial contact; (2) associations with symptom presentations, sex, and age with events in the diagnostic process and initial referrals and (3) the general practitioner’s (GP’s) evaluation of the diagnostic processes. Methods: all GPs in North-, central-, and southern Denmark were invited to fill in questionnaires for their listed patients diagnosed with cancer during the past two years. Results: among 1,032 recorded cRc patients, 65% had their initial contact in general practice, 5% within the out-of hours service, 10% in the hospital, and 20% were diagnosed based on screening. a total of 27% of cRc patients over 40 who initially presented in general practice were treated or referred on suspicion of another disease first, and 9% were reported to have had hesitated in seeking medical attention. some 37% presented solely non-specific symptoms, increasing the odds of the GP advising watchful waiting (OR 2.48; 95% ci 1.06–5.81), treating or referring on the suspicion of another illness first (OR 2.57; 95% ci 1.76–3.75), wait due to normal findings (OR 2.11; 95% ci 1.16–3.85), or referring to diagnostic imaging (OR 3.07; 95% ci 1.63–5.79). the GPs assessed nearly one fifth of the diagnostic processes as poor. Conclusion: Most cRc patients are diagnosed with initial presentation in general practice. having non-specific symptoms is common and challenges timely diagnosis. ARTICLE HISTORY Received 9 March 2024 accepted 17 November 2024 KEYWORDS colorectal cancer; General practice; Diagnosis; evaluation; symptoms Introduction colorectal cancer (cRc) stands as a significant global health concern due to its high incidence and mortality rates [1] . the prognosis of cRc is highly dependent onstage at diagnosis, and despite efforts to expedite the diagnostic process, most cRc cases are unfortunately still diagnosed in advanced stages, where curative treatment is hampered [2] . in many countries, cRc screening programmes have been established, but most cases of cRc are still to be diagnosed based on symptom presentation [3] . symptoms such as rectal bleeding, changes in bowel habits, and abdominal discomfort are well known alarm symptoms of c Rc; however, the positive predictive values are low – i.e. the symptoms are in most cases, caused by benign conditions [4] . therefore, the diagnosis can be challenging for the general practitioner (GP), who often is the patients’ initial contact in the diagnostic process and hence responsible for the initial assessments and referral for further investigations [5] . Moreover, it is known that the risk of an increased diagnostic primary care interval is substantially higher for patients where the GP does not initially suspect cancer [6] . although a recent study has shown that the number of contacts to general practice increase prior to diagnosis [7], barriers for healthcare seeking are common among individuals experiencing bowel symptoms [8], challenging CONTACT dorte e

FAQs

What is the main purpose of the Danish survey study?

The study aims to explore CRC diagnostic pathways, including where initial contact occurs, how symptoms relate to diagnostic events and referrals, and how GPs assess the diagnostic process.

Who participated in the study and how was data collected?

All GPs in North-, Central-, and Southern Denmark were invited to complete questionnaires covering patients they listed as diagnosed with cancer during the prior two years.

What were the reported patterns in patients’ initial contact?

Among 1,032 recorded CRC patients, 65% had initial contact in general practice, 5% were seen within out-of-hours services, 10% in hospital, and 20% were diagnosed via screening.

Sep 22, 2026

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