Appraisal and Diagnostic Delay in Colon Cancer

描述(由申请人提供)：少数族裔在癌症发病率、患病率和死亡率方面的差异已经有了很好的记录。尽管广泛和有针对性的癌症教育、筛查运动和癌症治疗的进步，这些差异仍然存在。诊断延迟与癌症患者的预后显著负相关。早期发现和诊断的重大障碍包括少数群体筛查率较低，以及由于缺乏医疗保险而出现的机会问题。然而，后来发现癌症并不完全是因为获得医疗保健的结构性障碍。越来越多的证据表明，文化和沟通因素可能在迟发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、解释和提请医生注意症状。第二，“诊断延迟”，定义为医生在诊断时的不作为或不正确的行为。我们将研究诊断延迟如何与无法理解、解释和有效地与患者沟通有关。这项研究的总体目标是了解这些因素是如何导致非裔美国人癌症检测延迟的，并将结肠癌作为这一现象的范例。本研究的具体目标如下：目的1.识别和检验影响评估延迟的因素，如患者对诊断前癌症症状的认知、感知和反应。我们将对144名最近诊断为结肠癌的患者进行定性访谈，以确定他们对最终导致癌症诊断的症状的解释。非裔美国人和白人癌症患者将进行比较。目的2.测试初级保健医生(PCP)是否与那些根据患者种族和性别不同而表现出癌症诊断前症状的患者进行沟通。为了做到这一点，我们将使用一个实验设计来比较110名PCP的样本的沟通模式和后续的患者管理决策，他们每个人都将与代表4个性别-种族组合的四个未经宣布的训练有素的患者模拟器会面。这个项目检验了最终被诊断为结肠癌的人识别他们的症状并与他们的医生沟通有多难。这项研究的主要目标是提高对癌症早期诊断障碍的理解，导致能够帮助医生和患者更有效地沟通的干预措施，并最终导致更早的癌症诊断。 公共卫生相关性：这个项目调查了最终被诊断为结肠癌的人识别他们的症状并与他们的医生沟通有多难。这项研究的主要目标是提高对癌症早期诊断障碍的理解，导致能够帮助医生和患者更有效地沟通的干预措施，并最终导致更早的癌症诊断。

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.