{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T03:28:58Z","timestamp":1792207738366,"version":"4.4.0"},"reference-count":87,"publisher":"Public Library of Science (PLoS)","issue":"6","license":[{"start":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T00:00:00Z","timestamp":1717977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003522","name":"Crohn's and Colitis UK","doi-asserted-by":"publisher","award":["7183"],"award-info":[{"award-number":["7183"]}],"id":[{"id":"10.13039\/501100003522","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>An improved understanding of the causes and experience of diagnostic delay in Inflammatory Bowel Disease (IBD).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Framework analysis of semi-structured interviews with 20 adults with IBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Participants\u2019 prior knowledge of normal bowel function\/IBD was limited. Symptoms were sometimes misattributed to mild\/transient conditions or normalised until intolerable. Family pressures, work, education, mistrust of doctors, fear and embarrassment could exacerbate delays. Poor availability of face-to-face appointments deterred people from seeing a GP. Patients feared that by the time they got to see their GP, their symptoms would have resolved. Patients instead self-managed symptoms, but often regretted not seeking help earlier. Limited time in consultations, language barriers, embarrassment, and delays in test results subsequently delayed specialist referrals. GPs misattributed symptoms to other conditions due to atypical or non-specific presentations, leading to reduced trust in health systems. Patients complained of poor communication, delays in accessing test results, appointments, and onward referrals\u2013all associated with clinical deterioration. GPs were sometimes unable to \u2018fast-track\u2019 patients into specialist care. Consultations and endoscopies were often difficult experiences for patients, especially for non-English speakers who are also less likely to receive information on mental health support and the practicalities of living with IBD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The framework analysis demonstrates delay in the diagnosis of IBD at each stage of the patient journey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec005\">\n                    <jats:title>Recommendations<\/jats:title>\n                    <jats:p>Greater awareness of IBD amongst the general population would facilitate presentation to healthcare services through symptom recognition by individuals and community advice. Greater awareness in primary care would help ensure IBD is included in differential diagnosis. In secondary care, greater attention to the wider needs of patients is needed\u2013beyond diagnosis and treatment. All clinicians should consider atypical presentations and the fluctuating nature of IBD. Diagnostic overshadowing is a significant risk\u2013where other diagnoses are already in play the risk of delay is considerable.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0301672","type":"journal-article","created":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T13:32:52Z","timestamp":1718026372000},"page":"e0301672","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":18,"title":["Sources of diagnostic delay for people with Crohn\u2019s disease and ulcerative colitis: Qualitative research study"],"prefix":"10.1371","volume":"19","author":[{"name":"AWARE-IBD Diagnostic Delay Working Group","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2024,6,10]]},"reference":[{"key":"pone.0301672.ref001","doi-asserted-by":"crossref","first-page":"46","DOI":"10.1053\/j.gastro.2011.10.001","article-title":"Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review","volume":"142","author":"NA Molodecky","year":"2012","journal-title":"Gastroenterology"},{"key":"pone.0301672.ref002","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1080\/03007995.2022.2043655","article-title":"The impact of symptom severity on the humanistic and economic burden of inflammatory bowel disease: a real-world data linkage study.","volume":"38","author":"AN Naegeli","year":"2022","journal-title":"Curr Med Res Opin"},{"key":"pone.0301672.ref003","doi-asserted-by":"crossref","first-page":"A496","DOI":"10.1016\/j.jval.2013.08.1109","article-title":"Systematic review: The economic burden of Crohn\u2019s disease in Europe in adults and children.","volume":"16","author":"D Floyd","year":"2013","journal-title":"Value Health"},{"key":"pone.0301672.ref004","doi-asserted-by":"crossref","first-page":"643","DOI":"10.1586\/14737167.2015.1045883","article-title":"Development of a conceptual model evaluating the humanistic and economic burden of Crohn\u2019s disease: implications for patient-reported outcomes measurement and economic evaluation","volume":"15","author":"A Gater","year":"2015","journal-title":"Expert Rev Pharmacoecon Outcomes Res"},{"key":"pone.0301672.ref005","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1007\/s12664-022-01303-x","article-title":"Diagnostic delay in adult inflammatory bowel disease: A systematic review","volume":"42","author":"E Cross","year":"2023","journal-title":"Indian J Gastroenterol"},{"key":"pone.0301672.ref006","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1111\/apt.17370","article-title":"Systematic review with meta-analysis: Time to diagnosis and the impact of delayed diagnosis on clinical outcomes in inflammatory bowel disease","volume":"57","author":"N Jayasooriya","year":"2023","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0301672.ref007","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1007\/s10620-016-4189-z","article-title":"Diagnostic Delay Is Associated with a Greater Risk of Early Surgery in a French Cohort of Crohn\u2019s Disease Patients","volume":"61","author":"S Nahon","year":"2016","journal-title":"Dig Dis Sci"},{"key":"pone.0301672.ref008","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/apt.15885","article-title":"Quality improvement project identifies factors associated with delay in IBD diagnosis","volume":"52","author":"GJ Walker","year":"2020","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0301672.ref009","doi-asserted-by":"crossref","first-page":"1825","DOI":"10.1097\/MIB.0000000000001257","article-title":"Impact of diagnostic delay and associated factors on clinical outcomes in a U.s. inflammatory bowel disease cohort","volume":"23","author":"VQ Nguyen","year":"2017","journal-title":"Inflamm Bowel Dis"},{"key":"pone.0301672.ref010","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1093\/ecco-jcc\/jjaa146","article-title":"Prevalence and duration of gastrointestinal symptoms before diagnosis of Inflammatory Bowel Disease and predictors of timely specialist review: a population-based study.","volume":"15","author":"J Blackwell","year":"2020","journal-title":"J Crohns Colitis"},{"key":"pone.0301672.ref011","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1016\/j.dld.2021.04.002","article-title":"Increased use of healthcare resources during the preclinical period of inflammatory bowel disease","volume":"53","author":"I Rodr\u00edguez-Lago","year":"2021","journal-title":"Dig Liver Dis"},{"key":"pone.0301672.ref012","doi-asserted-by":"crossref","first-page":"3270","DOI":"10.1007\/s10620-011-1783-y","article-title":"Prodromal irritable bowel syndrome may be responsible for delays in diagnosis in patients presenting with unrecognized Crohn\u2019s disease and celiac disease, but not ulcerative colitis","volume":"56","author":"SM Barratt","year":"2011","journal-title":"Dig Dis Sci"},{"key":"pone.0301672.ref013","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1136\/gutjnl-2019-318444","article-title":"Depression in inflammatory bowel disease: risk factor, prodrome or extraintestinal manifestation?","author":"CD Moulton","year":"2020","journal-title":"Gut. BMJ"},{"key":"pone.0301672.ref014","first-page":"3345","volume-title":"The American journal of gastroenterology.","author":"C Su","year":"2000"},{"key":"pone.0301672.ref015","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1136\/archdischild-2012-303056","article-title":"Safety netting in healthcare settings: what it means, and for whom?","volume":"99","author":"D Roland","year":"2014","journal-title":"Arch Dis Child Educ Pract Ed"},{"key":"pone.0301672.ref016","first-page":"1796","volume-title":"The American journal of gastroenterology.","author":"MD Long","year":"2010"},{"key":"pone.0301672.ref017","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1177\/1756283X15621230","article-title":"Overlapping irritable bowel syndrome and inflammatory bowel disease: less to this than meets the eye?","volume":"9","author":"EMM Quigley","year":"2016","journal-title":"Therap Adv Gastroenterol"},{"key":"pone.0301672.ref018","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1002\/ibd.20059","article-title":"Symptomatic overlap between irritable bowel syndrome and microscopic colitis.","volume":"13","author":"D Limsui","year":"2007","journal-title":"Inflamm Bowel Dis"},{"key":"pone.0301672.ref019","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1111\/j.1443-9573.2005.00202.x","article-title":"Irritable bowel syndrome and inflammatory bowel disease: interrelated diseases?","volume":"6","author":"EMM Quigley","year":"2005","journal-title":"Chin J Dig Dis"},{"key":"pone.0301672.ref020","doi-asserted-by":"crossref","first-page":"1474","DOI":"10.1038\/ajg.2012.260","article-title":"Prevalence of symptoms meeting criteria for irritable bowel syndrome in inflammatory bowel disease: systematic review and meta-analysis","volume":"107","author":"SJ Halpin","year":"2012","journal-title":"Am J Gastroenterol"},{"key":"pone.0301672.ref021","doi-asserted-by":"crossref","first-page":"3458","DOI":"10.1111\/j.1572-0241.2000.03361.x","article-title":"Identification of a prodromal period in Crohn\u2019s disease but not ulcerative colitis","volume":"95","author":"M Pimentel","year":"2000","journal-title":"Am J Gastroenterol"},{"key":"pone.0301672.ref022","doi-asserted-by":"crossref","first-page":"297","DOI":"10.5217\/ir.2016.14.4.297","article-title":"Irritable bowel syndrome and inflammatory bowel disease overlap syndrome: pieces of the puzzle are falling into place.","volume":"14","author":"R Abdul Rani","year":"2016","journal-title":"Intest Res"},{"key":"pone.0301672.ref023","doi-asserted-by":"crossref","first-page":"505","DOI":"10.1177\/2050640614554217","article-title":"Are IBD patients more likely to have a prior diagnosis of irritable bowel syndrome? Report of a case-control study in the General Practice Research Database","volume":"2","author":"TR Card","year":"2014","journal-title":"United European Gastroenterol J."},{"key":"pone.0301672.ref024","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1080\/003655200750024191","article-title":"Detection of colorectal tumor and inflammatory bowel disease during follow-up of patients with initial diagnosis of irritable bowel syndrome","volume":"35","author":"LA Garc\u00eda Rodr\u00edguez","year":"2000","journal-title":"Scand J Gastroenterol"},{"key":"pone.0301672.ref025","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1111\/apt.17042","article-title":"Inflammatory bowel disease patient-reported quality assessment should drive service improvement: a national survey of UK IBD units and patients","volume":"56","author":"AB Hawthorne","year":"2022","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0301672.ref026","doi-asserted-by":"crossref","first-page":"537","DOI":"10.5217\/ir.2018.00041","article-title":"IBD2020 global forum: results of an international patient survey on quality of care.","volume":"16","author":"P Irving","year":"2018","journal-title":"Intest Res"},{"key":"pone.0301672.ref027","first-page":"1","author":"BRK Yin","year":"1994","journal-title":"Case Study Research"},{"issue":"Pt 1","key":"pone.0301672.ref028","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1111\/j.2044-8309.1995.tb01047.x","article-title":"Delay in seeking a cancer diagnosis: delay stages and psychophysiological comparison processes.","volume":"34","author":"BL Andersen","year":"1995","journal-title":"Br J Soc Psychol"},{"key":"pone.0301672.ref029","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1186\/s12913-020-05821-2","article-title":"Parent\u2019s perspectives of the pathway to diagnosis of childhood cancer: a matter of diagnostic triage","volume":"20","author":"LH Pedersen","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"pone.0301672.ref030","doi-asserted-by":"crossref","first-page":"2761","DOI":"10.1007\/s11229-017-1355-6","article-title":"Systematizing the theoretical virtues.","volume":"195","author":"MN Keas","year":"2018","journal-title":"Synthese"},{"key":"pone.0301672.ref031","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1111\/j.1365-2923.2009.03295.x","article-title":"Conceptual frameworks to illuminate and magnify.","volume":"43","author":"G. Bordage","year":"2009","journal-title":"Med Educ"},{"key":"pone.0301672.ref032","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1007\/BF02090456","article-title":"The common-sense model of illness representation: Theoretical and practical considerations.","volume":"5","author":"M a Diefenbach","year":"1996","journal-title":"Journal of Social Distress and the Homeless"},{"key":"pone.0301672.ref033","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1016\/0010-0285(75)90024-9","article-title":"Family resemblances: Studies in the internal structure of categories","volume":"7","author":"E Rosch","year":"1975","journal-title":"Cogn Psychol"},{"key":"pone.0301672.ref034","doi-asserted-by":"crossref","first-page":"114523","DOI":"10.1016\/j.socscimed.2021.114523","article-title":"Sample sizes for saturation in qualitative research: A systematic review of empirical tests.","volume":"292","author":"M Hennink","year":"2022","journal-title":"Soc Sci Med"},{"key":"pone.0301672.ref035","doi-asserted-by":"crossref","first-page":"173","DOI":"10.4324\/9780203413081_chapter_9","volume-title":"Analysing qualitative data.","author":"J Ritchie","year":"1994"},{"key":"pone.0301672.ref036","first-page":"133","volume-title":"Case Study Research: Design and Methods","author":"RK Yin","year":"2014"},{"key":"pone.0301672.ref037","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1186\/s40900-018-0129-8","article-title":"Using qualitative Health Research methods to improve patient and public involvement and engagement in research.","volume":"4","author":"DE Rolfe","year":"2018","journal-title":"Res Involv Engagem"},{"key":"pone.0301672.ref038","doi-asserted-by":"crossref","first-page":"otaa027","DOI":"10.1093\/crocol\/otaa027","article-title":"Development and validation of the IBD-REFER criteria: Early referral for suspected inflammatory bowel diseases in adults and children.","volume":"2","author":"O Atia","year":"2020","journal-title":"Crohns Colitis 360."},{"key":"pone.0301672.ref039","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1111\/1756-185X.14482","article-title":"New-onset inflammatory arthritis after COVID-19 vaccination: A systematic review.","volume":"26","author":"C-C Chen","year":"2023","journal-title":"Int J Rheum Dis"},{"key":"pone.0301672.ref040","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/00005650-197901000-00002","article-title":"Determinants of three stages of delay in seeking care at a medical clinic.","volume":"17","author":"MA Safer","year":"1979","journal-title":"Med Care."},{"key":"pone.0301672.ref041","doi-asserted-by":"crossref","first-page":"400","DOI":"10.1093\/fampra\/cmn071","article-title":"Diagnostic difficulty and error in primary care\u2014a systematic review.","volume":"25","author":"O Kostopoulou","year":"2008","journal-title":"Fam Pract"},{"key":"pone.0301672.ref042","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1037\/0278-7393.19.5.1151","article-title":"Determinants of diagnostic hypothesis generation: effects of information, base rates, and experience.","volume":"19","author":"EU Weber","year":"1993","journal-title":"J Exp Psychol Learn Mem Cogn"},{"key":"pone.0301672.ref043","doi-asserted-by":"crossref","first-page":"1662","DOI":"10.1111\/jocn.16151","article-title":"Seeing the complete picture: A systematic review of mental health consumer and health professional experiences of diagnostic overshadowing.","volume":"32","author":"R Molloy","year":"2023","journal-title":"J Clin Nurs"},{"key":"pone.0301672.ref044","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1093\/fampra\/15.4.308","article-title":"The wrong diagnosis: identifying causes of potentially adverse events in general practice using incident monitoring.","volume":"15","author":"A. Bhasale","year":"1998","journal-title":"Fam Pract"},{"key":"pone.0301672.ref045","doi-asserted-by":"crossref","first-page":"i4843","DOI":"10.1136\/bmj.i4843","article-title":"Clinical assessment and management of multimorbidity: summary of NICE guidance","volume":"354","author":"C Farmer","year":"2016","journal-title":"BMJ"},{"key":"pone.0301672.ref046","doi-asserted-by":"crossref","first-page":"h176","DOI":"10.1136\/bmj.h176","article-title":"Managing patients with multimorbidity in primary care","volume":"350","author":"E Wallace","year":"2015","journal-title":"BMJ"},{"key":"pone.0301672.ref047","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1093\/ecco-jcc\/jjv178","article-title":"Ocular manifestations in inflammatory bowel disease are associated with other extra-intestinal manifestations, gender, and genes implicated in other immune-related traits.","volume":"10","author":"S Taleban","year":"2016","journal-title":"J Crohns Colitis"},{"key":"pone.0301672.ref048","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1186\/1750-1172-7-57","article-title":"Uveitis- a rare disease often associated with systemic diseases and infections- a systematic review of 2619 patients.","volume":"7","author":"T Barisani-Asenbauer","year":"2012","journal-title":"Orphanet J Rare Dis"},{"key":"pone.0301672.ref049","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/S0016-5085(67)80103-3","article-title":"Uveitis (iritis) associated with ulcerative and granulomatous colitis.","volume":"52","author":"BI Korelitz","year":"1967","journal-title":"Gastroenterology"},{"key":"pone.0301672.ref050","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/0304-3959(93)90165-L","article-title":"Patient-related barriers to management of cancer pain","volume":"52","author":"SE Ward","year":"1993","journal-title":"Pain"},{"key":"pone.0301672.ref051","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1111\/j.1467-9566.2004.00378.x","article-title":"Embodied health movements: new approaches to social movements in health.","volume":"26","author":"P Brown","year":"2004","journal-title":"Sociol Health Illn"},{"key":"pone.0301672.ref052","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1136\/pgmj.2003.015677","article-title":"Iron deficiency anaemia in general practice: clinical outcomes over three years and factors influencing diagnostic investigations.","volume":"80","author":"JM Yates","year":"2004","journal-title":"Postgrad Med J"},{"key":"pone.0301672.ref053","doi-asserted-by":"crossref","first-page":"169","DOI":"10.1177\/0272989X8600600307","article-title":"Premature conclusions in the diagnosis of iron-deficiency anemia: cause and effect.","volume":"6","author":"CE Dubeau","year":"1986","journal-title":"Med Decis Making"},{"key":"pone.0301672.ref054","doi-asserted-by":"crossref","first-page":"A235.1","DOI":"10.1136\/gutjnl-2014-307263.506","article-title":"PTH-060 evaluation of an established community gastroenterology clinic with comparison to secondary care","volume":"63","author":"OF Ahmad","year":"2014","journal-title":"Gut"},{"key":"pone.0301672.ref055","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1136\/qshc.8.1.16","article-title":"Left in limbo: patients\u2019 views on care across the primary\/secondary interface.","volume":"8","author":"C Preston","year":"1999","journal-title":"Qual Health Care"},{"key":"pone.0301672.ref056","article-title":"\u201cI just need a plan\u201d: Consumer perceptions of waiting for healthcare.","author":"KE Harding","year":"2023","journal-title":"J Eval Clin Pract."},{"key":"pone.0301672.ref057","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/jnci\/94.3.167","article-title":"All-cause mortality in randomized trials of cancer screening","volume":"94","author":"WC Black","year":"2002","journal-title":"J Natl Cancer Inst"},{"key":"pone.0301672.ref058","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.pec.2009.07.015","article-title":"From support to boundary: a qualitative study of the border between self-care and professional care.","volume":"79","author":"T Kielmann","year":"2010","journal-title":"Patient Educ Couns"},{"key":"pone.0301672.ref059","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1111\/j.1471-6712.2008.00601.x","article-title":"Patient-related barriers to cancer pain management: a systematic exploratory review","volume":"23","author":"R Jacobsen","year":"2009","journal-title":"Scand J Caring Sci"},{"key":"pone.0301672.ref060","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1093\/fampra\/7.2.84","article-title":"General practitioners\u2019 comments on video recorded consultations as an aid to understanding the doctor-patient relationship.","volume":"7","author":"E Arborelius","year":"1990","journal-title":"Fam Pract"},{"key":"pone.0301672.ref061","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/S0163-8343(97)00042-X","article-title":"Predictors of physician frustration in the care of patients with rheumatological complaints.","volume":"19","author":"EA Walker","year":"1997","journal-title":"Gen Hosp Psychiatry"},{"key":"pone.0301672.ref062","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1111\/jep.13740","article-title":"(Dis)respect and shame in the context of \u201cmedically unexplained\u201d illness","volume":"28","author":"K. Cheston","year":"2022","journal-title":"J Eval Clin Pract"},{"key":"pone.0301672.ref063","doi-asserted-by":"crossref","first-page":"e053239","DOI":"10.1136\/bmjopen-2021-053239","article-title":"How do National Health Service (NHS) organisations respond to patient concerns? A qualitative interview study of the Patient Advice and Liaison Service (PALS).","volume":"11","author":"K Shepard","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0301672.ref064","doi-asserted-by":"crossref","first-page":"920","DOI":"10.3109\/00365529709011203","article-title":"Stool form scale as a useful guide to intestinal transit time","volume":"32","author":"SJ Lewis","year":"1997","journal-title":"Scand J Gastroenterol"},{"key":"pone.0301672.ref065","doi-asserted-by":"crossref","first-page":"e044033","DOI":"10.1136\/bmjopen-2020-044033","article-title":"Patient-initiated second medical consultations-patient characteristics and motivating factors, impact on care and satisfaction: a systematic review","volume":"11","author":"G Greenfield","year":"2021","journal-title":"BMJ Open"},{"key":"pone.0301672.ref066","doi-asserted-by":"crossref","first-page":"h6237","DOI":"10.1136\/bmj.h6237","article-title":"Identify sepsis in patients by using early warning scores, doctors are urged","volume":"351","author":"Z. Kmietowicz","year":"2015","journal-title":"BMJ"},{"key":"pone.0301672.ref067","doi-asserted-by":"crossref","first-page":"i6361","DOI":"10.1136\/bmj.i6361","article-title":"Clinical commissioning groups will be rated on sepsis care","volume":"355","author":"J. Wise","year":"2016","journal-title":"BMJ"},{"key":"pone.0301672.ref068","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1111\/j.1365-2036.2006.02956.x","article-title":"Utility of red flag symptom exclusions in the diagnosis of irritable bowel syndrome","volume":"24","author":"WE Whitehead","year":"2006","journal-title":"Aliment Pharmacol Ther"},{"key":"pone.0301672.ref069","doi-asserted-by":"crossref","first-page":"1761","DOI":"10.1038\/s41591-021-01498-0","article-title":"Anemia prevalence in women of reproductive age in low- and middle-income countries between 2000 and 2018","volume":"27","author":"Local Burden of Disease Anaemia Collaborators","year":"2021","journal-title":"Nat Med"},{"key":"pone.0301672.ref070","article-title":"Evaluating the accuracy of hemorrhoids: Comparison among specialties and symptoms","author":"JJ Idrees","year":"2019","journal-title":"Dis Colon Rectum"},{"issue":"Suppl","key":"pone.0301672.ref071","doi-asserted-by":"crossref","first-page":"8","DOI":"10.3109\/13814788.2015.1043123","article-title":"Reducing diagnostic errors in primary care. A systematic meta-review of computerized diagnostic decision support systems by the LINNEAUS collaboration on patient safety in primary care.","volume":"21","author":"M Nurek","year":"2015","journal-title":"Eur J Gen Pract."},{"key":"pone.0301672.ref072","doi-asserted-by":"crossref","first-page":"i5515","DOI":"10.1136\/bmj.i5515","article-title":"Can safety-netting improve cancer detection in patients with vague symptoms?","volume":"355","author":"BD Nicholson","year":"2016","journal-title":"BMJ"},{"key":"pone.0301672.ref073","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.3399\/bjgp18X700193","article-title":"Safety netting for primary care: evidence from a literature review.","volume":"69","author":"D Jones","year":"2019","journal-title":"Br J Gen Pract"},{"key":"pone.0301672.ref074","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1136\/bmjqs-2021-014529","article-title":"Optimising GPs\u2019 communication of advice to facilitate patients\u2019 self-care and prompt follow-up when the diagnosis is uncertain: a realist review of \u201csafety-netting\u201d in primary care.","volume":"31","author":"C Friedemann Smith","year":"2022","journal-title":"BMJ Qual Saf"},{"key":"pone.0301672.ref075","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1136\/bmj.330.7494.781","article-title":"Five pitfalls in decisions about diagnosis and prescribing","volume":"330","author":"JG Klein","year":"2005","journal-title":"BMJ"},{"key":"pone.0301672.ref076","doi-asserted-by":"crossref","first-page":"e068044","DOI":"10.1136\/bmj-2021-068044","article-title":"Five strategies for clinicians to advance diagnostic excellence","volume":"376","author":"H Singh","year":"2022","journal-title":"BMJ"},{"key":"pone.0301672.ref077","doi-asserted-by":"crossref","first-page":"b1860","DOI":"10.1136\/bmj.b1860","article-title":"Errors in clinical reasoning: causes and remedial strategies","volume":"338","author":"IA Scott","year":"2009","journal-title":"BMJ"},{"key":"pone.0301672.ref078","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1186\/s41235-022-00460-z","article-title":"The challenge of cognitive science for medical diagnosis","volume":"8","author":"P Croskerry","year":"2023","journal-title":"Cogn Res Princ Implic"},{"key":"pone.0301672.ref079","doi-asserted-by":"crossref","first-page":"979","DOI":"10.1007\/s11739-021-02884-9","article-title":"Clinical reasoning in dire times. Analysis of cognitive biases in clinical cases during the COVID-19 pandemic.","volume":"17","author":"M Coen","year":"2022","journal-title":"Intern Emerg Med"},{"key":"pone.0301672.ref080","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.jaad.2019.06.1286","article-title":"Confirmation bias in medical decision-making","volume":"82","author":"DM Elston","year":"2020","journal-title":"J Am Acad Dermatol"},{"key":"pone.0301672.ref081","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1177\/2050640617700014","article-title":"Performance measures for lower gastrointestinal endoscopy: a European Society of Gastrointestinal Endoscopy (ESGE) quality improvement initiative.","volume":"5","author":"MF Kaminski","year":"2017","journal-title":"United European Gastroenterol J"},{"key":"pone.0301672.ref082","doi-asserted-by":"crossref","first-page":"242","DOI":"10.3390\/diagnostics12020242","article-title":"Patient-reported experience measures for colonoscopy: A systematic review and meta-ethnography.","volume":"12","author":"A Rosvall","year":"2022","journal-title":"Diagnostics (Basel)."},{"key":"pone.0301672.ref083","doi-asserted-by":"crossref","first-page":"1096","DOI":"10.1093\/ibd\/izaa257","article-title":"Ulcerative Colitis Narrative global survey findings: Communication gaps and agreements between patients and physicians.","volume":"27","author":"DT Rubin","year":"2021","journal-title":"Inflamm Bowel Dis."},{"key":"pone.0301672.ref084","doi-asserted-by":"crossref","first-page":"2449","DOI":"10.1200\/JCO.1995.13.9.2449","article-title":"Breaking bad news: consensus guidelines for medical practitioners.","volume":"13","author":"A Girgis","year":"1995","journal-title":"J Clin Oncol."},{"key":"pone.0301672.ref085","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1001\/jama.1996.03540060072041","article-title":"Breaking bad news. A review of the literature","volume":"276","author":"JT Ptacek","year":"1996","journal-title":"JAMA"},{"key":"pone.0301672.ref086","doi-asserted-by":"crossref","first-page":"e879","DOI":"10.1634\/theoncologist.2020-0284","article-title":"Breaking bad news via telemedicine: A new challenge at times of an epidemic.","volume":"25","author":"I Wolf","year":"2020","journal-title":"Oncologist"},{"key":"pone.0301672.ref087","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1097\/00054725-200407000-00020","article-title":"Communicating with patients with inflammatory bowel disease.","volume":"10","author":"A Husain","year":"2004","journal-title":"Inflamm Bowel Dis"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301672","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,6,10]],"date-time":"2024-06-10T13:33:46Z","timestamp":1718026426000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0301672"}},"subtitle":[],"editor":[{"given":"Val\u00e9rie","family":"Pittet","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2024,6,10]]},"references-count":87,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2024,6,10]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0301672","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,6,10]]}}}