Development of the questionnaire

The Örenäs Research Group is a European group of primary care researchers that studies the primary care factors that relate to cancer survival. After a literature review, Örenäs Research Group investigators developed a questionnaire designed to elicit PCPs’ referral decisions on patients who could have cancer, and their degree of agreement with items relating to health system aspects that could affect their decision to refer patients with potential cancer symptoms for further investigation. The final, open-ended question asked: “How do you think the speed of diagnosis of cancer in primary care could be improved?” The answers to this question are used in this analysis.

The questionnaire was piloted twice by PCPs in 16 Örenäs Research Group centres. No changes were made to the final, open-ended question after either of the piloting stages. Örenäs Research Group leads arranged for translations of the questionnaire into their local languages where these were not English, a total of 19 translations from the original English. Translation, validation by back-translation to assess semantic and conceptual equivalence, and cultural adaptation³⁴ of the survey were done in a standardised way³⁵ and are described elsewhere.³⁶ The questionnaires were put online using SurveyMonkey (SurveyMonkey, California, USA).