Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation

被引：0
作者：
G Lyratzopoulos
P Vedsted
H Singh
机构：
[1] Health Behaviour Research Centre,Department of Epidemiology and Public Health
[2] University College London,Department of Public Health and Primary Care
[3] Cambridge Centre for Health Services Research,Department of Public Health
[4] University of Cambridge,Department of Medicine
[5] Institute of Public Health,undefined
[6] Research Unit for General Practice,undefined
[7] Research Centre for Cancer Diagnosis in Primary Care (CaP),undefined
[8] Aarhus University,undefined
[9] DK-Bartholins Allé,undefined
[10] 8000 Aarhus,undefined
[11] Denmark,undefined
[12] Houston Veterans Affairs Center for Innovations in Quality,undefined
[13] Effectiveness and Safety,undefined
[14] Michael E. DeBakey Veterans Affairs Medical Center and the Section of Health Services Research,undefined
[15] Baylor College of Medicine,undefined
来源：
British Journal of Cancer | 2015年 / 112卷
关键词：
neoplasm; diagnosis; missed opportunities; patient safety; general practice; system factors; errors; quality;
D O I：
暂无
中图分类号：
学科分类号：
摘要：
The diagnosis of cancer is a complex, multi-step process. In this paper, we highlight factors involved in missed opportunities to diagnose cancer more promptly in symptomatic patients and discuss responsible mechanisms and potential strategies to shorten intervals from presentation to diagnosis. Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis. They can occur in any of the three phases of the diagnostic process (initial diagnostic assessment; diagnostic test performance and interpretation; and diagnostic follow-up and coordination) and can involve patient, doctor/care team, and health-care system factors, often in combination. In this perspective article, we consider epidemiological ‘signals’ suggestive of missed opportunities and draw on evidence from retrospective case reviews of cancer patient cohorts to summarise factors that contribute to missed opportunities. Multi-disciplinary research targeting such factors is important to shorten diagnostic intervals post presentation. Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda. We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.
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页码：S84 / S91
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  • [1] Ahrensberg JM(2013)Use of primary care during the year before childhood cancer diagnosis: a nationwide population-based matched comparative study PLoS One 8 e59098-874
  • [2] Fenger-Grøn M(2009)Diagnostic safety-netting Br J Gen Pract 59 872-255
  • [3] Vedsted P(2014)Global Health Care-seeking Discourses Facing Local Clinical Realities: Exploring the Case of Cancer Medical Anthropology Quarterly 29 237-149
  • [4] Almond S(2011)Does the organizational structure of health care systems influence care-seeking decisions? A qualitative analysis of Danish cancer patients' reflections on care-seeking Scand J Prim Health Care 29 144-43
  • [5] Mant D(2012)Identifying early warning signs for diagnostic errors in primary care: a qualitative study BMJ Open 2 e001539-S91
  • [6] Thompson M(2012)Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study Lancet 380 37-868
  • [7] Andersen Rikke Sand(2009)Auditing the diagnosis of cancer in primary care: the experience in Scotland Br J Cancer 101 S87-63
  • [8] Tørring Marie Louise(2014)Responding to symptoms suggestive of lung cancer: a qualitative interview study BMJ Open Respir Res 1 e000067-2448
  • [9] Vedsted Peter(2006)Delay in diagnosis of lung cancer in general practice Br J Gen Pract 56 863-995
  • [10] Andersen RS(2014)How might healthcare systems influence speed of cancer diagnosis: A narrative review Soc Sci Med 116C 56-1226
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