Gender and race differences in factors related to diagnostic delay in colorectal cancer

Delay in making a cancer diagnosis may result from appraisal delay (or difficulty recognizing and interpreting symptoms), structural problems that create barriers to access to care, and/or communication problems between patients and providers. Gender and cultural factors may influence these processes and account for some well-documented health disparities. This study examines how communication as influenced by patient gender and race may result in delay in obtaining a diagnosis of colorectal cancer. Using a multimethod approach of semistructured patient interviews and medical record reviews, we are examining the disease histories of 200 patients diagnosed with colorectal cancer in the past 6 months in the Richmond, VA and Cleveland, OH metropolitan areas. The semi-structured patient interviews focuses on: 1) symptom recognition and appraisal, 2) influence of family members and friends, 3) social support, 4) ease of access to care, 5) communication with health care provider, and 6) socio-demographic and psychological factors. The sample to date (n= 68) is 50% male and 56% Caucasian. Recall has been excellent. 78% of participants to date reported high clarity and accuracy concerning the events leading up to their diagnosis. The qualitative data also indicates that appraisal delay is influenced by 1) difficulties with initial symptom identification, 2) inaccurate symptom interpretation and/or attribution, and 3) psychosocial factors. We will be identifying specific predictors of diagnostic delay and quantifying gender and race differences among these predictors.