Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review.
Influences on pre-hospital delay in the diagnosis of colorectal cancer: a systematic review.
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对大肠癌诊断前院前延迟的影响：系统评价。
DOI：
10.1038/sj.bjc.6604096
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发表时间：
2008-01-15
影响因子：
8.8
通讯作者：
Macleod, U.
中科院分区：
文献类型：
--
作者：
Mitchell, E.;Macdonald, S.;Campbell, N. C.;Weller, D.;Macleod, U.
结直肠癌是一个主要的全球健康问题，根据诊断阶段的不同，生存率也不同。延误诊断可由患者、医生或医院延误造成。本文报告了影响院前延迟的因素的回顾结果-患者首次注意到癌症症状和就诊于初级保健之间的时间或首次就诊与转诊至二级保健之间的时间。采用了系统的方法，包括广泛检索1970年至2003年发表的文献，系统的数据提取，质量评估和叙事数据综合。共纳入54项研究。患者对症状严重性的不认识增加了延迟，就像症状否认一样。直肠癌患者的延迟时间比结肠癌患者的延迟时间要长，而存在更严重的症状，如疼痛，则会减少延迟时间。延迟与患者的年龄、性别或社会经济地位之间似乎没有关系。最初的误诊、不充分的检查和不准确的调查增加了医生的延误。使用转诊指南可以减少延误，尽管目前证据有限。未发现干预研究。如果要减少延迟诊断，就必须提高对患者症状重要性的认识，并制定和评估旨在确保从业人员进行适当诊断和检查的干预措施。
Colorectal cancer is a major global health problem, with survival varying according to stage at diagnosis. Delayed diagnosis can result from patient, practitioner or hospital delay. This paper reports the results of a review of the factors influencing pre-hospital delay – the time between a patient first noticing a cancer symptom and presenting to primary care or between first presentation and referral to secondary care. 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. Fifty-four studies were included. Patients' non-recognition of symptom seriousness increased delay, as did symptom denial. Patient delay was greater for rectal than colon cancers and the presence of more serious symptoms, such as pain, reduced delay. There appears to be no relationship between delay and patients' age, sex or socioeconomic status. Initial misdiagnosis, inadequate examination and inaccurate investigations increased practitioner delay. Use of referral guidelines may reduce delay, although evidence is currently limited. No intervention studies were identified. If delayed diagnosis is to be reduced, there must be increased recognition of the significance of symptoms among patients, and development and evaluation of interventions that are designed to ensure appropriate diagnosis and examination by practitioners.
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影响因子：
2.8
作者：
Carter, S;Winslet, M
通讯作者：
Winslet, M
影响因子：
6.7
作者：
CURLESS, R;FRENCH, JM;JAMES, OFW
通讯作者：
JAMES, OFW
影响因子：
--
作者：
DIXON, AR;THORNTONHOLMES, J;CHEETHAM, NM
通讯作者：
CHEETHAM, NM
影响因子：
6.3
作者：
MACARTHUR, C;SMITH, A
通讯作者：
SMITH, A
影响因子：
9.6
作者：
GOODMAN, D;IRVIN, TT
通讯作者：
IRVIN, TT