Appraisal and Diagnostic Delay in Colon Cancer

结肠癌的评估和诊断延迟

基本信息

批准号：
8267087
负责人：
Maria D. Thomson
金额：
$ 61.16万
依托单位：
VIRGINIA COMMONWEALTH UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-08-01 至 2014-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8267087
关键词：
African American Attention Breast Cancer Detection Cancer Patient Characteristics Colon Colon Carcinoma Colorectal Communication Detection Diagnosis Diagnostic Disease Early Diagnosis Effectiveness Exhibits Experimental Designs Failure Female Gender Goals Health Insurance Health Personnel Healthcare Incidence Intervention Interview Lead Low Income Population Lung Malignant Neoplasms Malignant neoplasm of cervix uteri Malignant neoplasm of prostate Medical Methodology Minority Minority Groups Newly Diagnosed Outcome Patient Education Patients Pattern Perception Physicians Play Prevalence Primary Care Physician Primary Health Care Provider Race Recommendation Reporting Role Sampling Screening procedure Simulate Staging Structure Symptoms Testing Uterine Cancer Woman cancer diagnosis cancer education cancer health disparity cancer therapy caucasian American experience improved instrument male malignant breast neoplasm malignant mouth neoplasm meetings men mortality public health relevance response

项目摘要

DESCRIPTION (provided by applicant): Disparities in cancer incidence, prevalence, and mortality have been well-documented for racial/ethnic minorities. These disparities persist despite widespread and targeted cancer education, screening campaigns, and advancements in cancer therapy. Diagnostic delay is significantly and negatively associated with cancer patient outcomes. Substantial barriers to early detection and diagnosis include lower rates of screening by minorities and access issues due to lack of health insurance. Later detection of cancer, however, is not solely explained by structural barriers to obtaining health care. Evidence has accumulated that cultural and communication factors may play a role in outcome disparities caused by late detection. We propose to examine two important factors that are likely to contribute to a delay in the diagnosis of cancer. First, `appraisal delay', defined as patients' inability to identify, interpret, and bring symptoms to the attention of their physicians. Second, 'diagnostic delay', defined as physicians' inaction or incorrect actions to make a diagnosis. We will examine how diagnostic delay may be associated with an inability to understand, interpret, and communicate effectively with patients. The overall goal of this study is to understand how these factors contribute to delay in detecting cancers in African-Americans, using colon cancer as a paradigm for this phenomenon. The study's specific aims are as follows: Aim 1. Identify and examine the factors that influence appraisal delay, e.g., patients' recognition, perception, and response to pre-diagnosis cancer symptoms. We will conduct qualitative interviews with 144 recently diagnosed colon cancer patients to identify their interpretations of the symptoms that eventually result in a diagnosis of cancer. African-American and white cancer patients will be compared. Aim 2. Test whether or not primary care physicians (PCPs) communicate with patients who present pre-diagnosis symptoms of cancer to PCPs differently depending on patient race and gender. To accomplish this, we will use an experimental design to compare the communication patterns and subsequent patient management decisions of a sample of 110 PCPs who will each meet with four unannounced trained patient simulators representing 4 gender-race combinations.This project examines how hard it was for people who are eventually diagnosed with colon cancer to recognize and communicate their symptoms to their physicians. The study's main goal is to improve understanding of the barriers to early diagnosis of cancer, lead to interventions that can help doctors and patients communicate more effectively, and ultimately lead to earlier cancer diagnoses. Public Health Relevance: This project examines how hard it was for people who are eventually diagnosed with colon cancer to recognize and communicate their symptoms to their physicians. The study's main goal is to improve understanding of the barriers to early diagnosis of cancer, lead to interventions that can help doctors and patients communicate more effectively, and ultimately lead to earlier cancer diagnoses.

描述（由申请人提供）：少数种族/族裔在癌症发病率、患病率和死亡率方面的差异已得到充分记录。尽管开展了广泛且有针对性的癌症教育、筛查活动以及癌症治疗的进步，但这些差异仍然存在。诊断延迟与癌症患者的预后显着负相关。早期发现和诊断的重大障碍包括少数族裔筛查率较低以及由于缺乏健康保险而导致的准入问题。然而，癌症的晚期检测并不能仅仅用获得医疗保健的结构性障碍来解释。越来越多的证据表明，文化和沟通因素可能在晚发现造成的结果差异中发挥作用。我们建议检查两个可能导致癌症诊断延迟的重要因素。首先，“评估延迟”，定义为患者无法识别、解释症状并将其引起医生的注意。其次，“诊断延迟”，定义为医生不采取行动或采取不正确的诊断行动。我们将研究诊断延迟如何与无法理解、解释和与患者有效沟通相关。这项研究的总体目标是了解这些因素如何导致非洲裔美国人癌症检测延迟，并以结肠癌作为这种现象的范例。该研究的具体目标如下：目标 1. 识别并检查影响评估延迟的因素，例如患者对诊断前癌症症状的认知、感知和反应。我们将对 144 名最近诊断出的结肠癌患者进行定性访谈，以确定他们对最终导致癌症诊断的症状的解释。将比较非裔美国人和白人癌症患者。目标 2. 测试初级保健医生 (PCP) 是否会根据患者种族和性别的不同，与向 PCP 提出癌症诊断前症状的患者进行不同的沟通。为了实现这一目标，我们将使用实验设计来比较 110 名 PCP 样本的沟通模式和随后的患者管理决策，这些样本中的每名 PCP 都会与代表 4 种性别种族组合的 4 名未经宣布的训练有素的患者模拟器会面。该项目研究了这有多困难对于最终被诊断患有结肠癌的人来说，可以识别他们的症状并向医生传达他们的症状。该研究的主要目标是提高对癌症早期诊断障碍的了解，采取干预措施帮助医生和患者更有效地沟通，并最终实现早期癌症诊断。公共卫生相关性：该项目研究了最终被诊断患有结肠癌的人识别并向医生传达其症状的难度。该研究的主要目标是提高对癌症早期诊断障碍的了解，采取干预措施帮助医生和患者更有效地沟通，并最终实现早期癌症诊断。

项目成果

期刊论文数量（4）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Incorporating patient and family preferences into evidence-based medicine.

将患者和家属的偏好纳入循证医学。

DOI：
发表时间：
2013
期刊：
影响因子：
0
作者：
Siminoff; Laura A
通讯作者：
Laura A

Internet use for prediagnosis symptom appraisal by colorectal cancer patients.

互联网用于结直肠癌患者的诊断前症状评估。

DOI：
发表时间：
2012-10
期刊：
影响因子：
0
作者：
Thomson, Maria D;Siminoff, Laura A;Longo, Daniel R
通讯作者：
Longo, Daniel R

Doctor, what's wrong with me? Factors that delay the diagnosis of colorectal cancer.

医生，我这是怎么了？

DOI：
发表时间：
2011-09
期刊：
影响因子：
3.5
作者：
Siminoff LA;Rogers HL;Thomson MD;Dumenci L;Harris-Haywood S
通讯作者：
Harris-Haywood S

The advantages and challenges of unannounced standardized patient methodology to assess healthcare communication.

用于评估医疗保健沟通的未公布的标准化患者方法的优点和挑战。

DOI：
10.1016/j.pec.2011.01.021
发表时间：
2011-03
期刊：
Patient education and counseling
影响因子：
3.5
作者：
Siminoff LA;Rogers HL;Waller AC;Harris-Haywood S;Esptein RM;Carrio FB;Gliva-McConvey G;Longo DR
通讯作者：
Longo DR