The following might help to reduce diagnostic delay: Information regarding the signs and symptoms of CRC, how to obtain a proper detailed history and physical examination, appropriate investigations, and referral of patients presenting with suspicious signs and symptoms should be widely disseminated to FPs and other PCPs using various knowledge translation strategies During the periodic health examination, FPs and other PCPs should ask adult patients about rectal bleeding, changes in bowel habits, and unintentional weight loss While discussing CRC screening with patients, FPs and other PCPs should ask about family history of CRC and the signs and symptoms predictive of CRC FPs and other PCPs should investigate unexplained anemia, especially iron deficiency anemia (refer to anemia guidelines9,10) For signs and symptoms that might not have prompted initial referral, FPs and other PCPs should reassess and perform further workup if signs or symptoms do not resolve FPs and other PCPs should consider training staff regarding triaging of patients calling with signs or symptoms suggestive of CRC to expedite initial appointments Specialists competent in endoscopy should develop triage protocols to avoid delays in the diagnosis of CRC in patients with suspicious signs or symptoms Sustainable public education about the signs and symptoms of CRC, the importance of early detection and management, and common fears and concerns that might delay referral should be developed and implemented Special efforts should be made to reduce delays in presentation often observed among women, single patients, younger patients, visible minorities, and patients with comorbidities, decreased social support, lower levels of education, or rural residence
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