Review for 10.1186/1471-230X-12-100 (2012)

Reviewer's report
Title:Factors associated with consultation behaviour for primary symptoms
potentially indicating colorectal cancer: A cross-sectional study on response to
symptoms.
Version: 1Date:14 March 2012
Reviewer: Alice Simon
Reviewer's report:
This paper has potential. There is a clear need for further research in this area.
The large sample has made it possible to investigate help-seeking behaviour for
particular bowel symptoms and this is a useful contribution. However, there is
some work that could still be done to improve the paper. None of the issues
raised are insurmountable and ultimately this paper will be well worth publishing.
Major compulsory revisions
1. Introduction: A little more information about the symptoms of rectal bleeding
and change in bowel habit would be useful. Are these symptoms associated with
a primary tumour? Are duration of these symptoms associated with survival?
These issues are clearly important for making the argument that prompt
help-seeking for these symptoms is beneficial. The first two sentences of
paragraph 3 could be the place to redraft/add further information on these. The
work of Willie Hamilton speaks to these issues – and I note one of his papers is
included (ref 14).
2. P4 (and elsewhere, e.g. P11) refers to a ‘prospective longitudinal design’. I
think this is mis-leading - I understand that the Hunter Community Study has a
planned longitudinal design. However the data presented here are from a one-off
questionnaire asking people to recall their symptoms and help-seeking
behaviour. This is a retrospective study. I can see no longitudinal (ie repeated
measures/observations) data reported. (NB This use of the term 'longitudinal'
also contradicts the title which refers to a 'cross-sectional' study)
3. Method/results: Why is 5 years considered a good cut-off for reducing recall
bias? This seems a very long period. Using this cut-off also confuses the results.
Currently we can’t compare ‘ever’ help-seeking for this group with ‘early’
help-seeking – how do the full vs 5 year group differ for both of these analyses?
4. Why is early help-seeking defined as <2 weeks for rectal bleeding and < 4
weeks for change in bowel habit? Is this clinically meaningful? Please justify.
5. P6 states that the list of predictors was selected a priori based on existing
literature. There is a very long list of potential predictors – many more than
mentioned in the ‘introduction’ so the justification for including many of these is
not particularly clear. It might be helpful to try and describe these within some
form of help-seeking model or framework?
6. Why are CRC patients and abdominal surgeries removed from the analyses?
Surely their help-seeking behaviours are relevant? Please justify.
Discretionary revisions
7. Method: Overall the method section could be laid out better to improve clarity
e.g. with greater details about what the question stems and response options
were. e.g. P6 What are the ‘symptom characteristics’? Please describe.
8. Discussion: The result on male help-seeking behaviour appears inconsistent
with other literature. Why might this be? A true finding, something peculiar to
bowel symptoms, or an issue with the sample/measures etc?
Level of interest: An article of importance in its field
Quality of written English: Acceptable
Statistical review: No, the manuscript does not need to be seen by a
statistician.
Declaration of competing interests:
I declare that I have no competing interests