Systematic review of factors influencing patient and practitioner delay in diagnosis of upper gastrointestinal cancer
Systematic review of factors influencing patient and practitioner delay in diagnosis of upper gastrointestinal cancer
复制标题
DOI：
10.1038/sj.bjc.6603089
复制
发表时间：
2006-05-08
影响因子：
8.8
通讯作者：
Mitchell, E
中科院分区：
文献类型：
--
作者：
Macdonald, S;Macleod, U;Mitchell, E
随着对癌症病因的认识的进步和新治疗方法的开发，早期识别和准确诊断变得越来越重要。本文综述了影响上消化道癌症患者和初级保健医生延迟治疗的因素。采用系统的方法，包括广泛检索1970年至2003年发表的文献，系统的数据提取，质量评估和叙述性数据合成。纳入的研究是那些评估与患者首次注意到癌症症状和出现初级保健之间的时间间隔相关的因素，患者首次出现初级保健和被转诊到二级保健之间的时间间隔，或描述旨在缩短这些间隔的干预措施。25项研究被纳入审查。报告延迟间隔的研究表明，患者阶段的延迟大于从业者阶段，而患者相关研究表明，识别症状严重性比识别症状的存在更重要。医生延误的主要因素是误诊，应用和解释的测试，和现有疾病的混杂效应。需要更好地了解患者因素，沿着评估干预措施，以确保适当的诊断、检查和调查。
As knowledge on the causation of cancers advances and new treatments are developed, early recognition and accurate diagnosis becomes increasingly important. This review focused on identifying factors influencing patient and primary care practitioner delay for upper gastrointestinal cancer. A systematic methodology was applied, including extensive searches of the literature published from 1970 to 2003, systematic data extraction, quality assessment and narrative data synthesis. Included studies were those evaluating factors associated with the time interval between a patient first noticing a cancer symptom and presenting to primary care, between a patient first presenting to primary care and being referred to secondary care, or describing an intervention designed to reduce those intervals. Twenty-five studies were included in the review. Studies reporting delay intervals demonstrated that the patient phase of delay was greater than the practitioner phase, whilst patient-related research suggests that recognition of symptom seriousness is more important than recognition of the presence of the symptom. The main factors related to practitioner delay were misdiagnosis, application and interpretation of tests, and the confounding effect of existing disease. Greater understanding of patient factors is required, along with evaluation of interventions to ensure appropriate diagnosis, examination and investigation.