Appraisal and Diagnostic Delay in Colon Cancer

描述（由申请人提供）：种族/少数民族在癌症发病率、患病率和死亡率方面的差异已经得到了充分的证明。尽管广泛而有针对性的癌症教育、筛查活动和癌症治疗取得了进展，但这些差异仍然存在。诊断延迟与癌症患者预后显著负相关。早期发现和诊断的重大障碍包括少数群体的筛查率较低以及由于缺乏医疗保险而导致的获取问题。然而，较晚发现癌症并不能完全用获得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期发现造成的结果差异中发挥作用。我们建议检查可能导致癌症诊断延迟的两个重要因素。首先，“评估延迟”，定义为患者无法识别、解释并将症状提请医生注意。第二，“诊断延误”，定义为医生在做出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、解释和与患者有效沟通有关。本研究的总体目标是了解这些因素是如何导致非洲裔美国人延迟发现癌症的，以结肠癌为例。本研究的具体目的如下：目的1。识别和检查影响评估延迟的因素，例如患者对诊断前癌症症状的识别、感知和反应。我们将对144名最近确诊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。非裔美国人和白人癌症患者将进行比较。目标2。测试初级保健医生（pcp）是否根据患者的种族和性别与呈现癌症诊断前症状的患者进行不同程度的沟通。为了实现这一目标，我们将采用实验设计来比较110名pcp的沟通模式和随后的患者管理决策，这些pcp将分别与代表4种性别种族组合的4名未经通知的训练有素的患者模拟器会面。这个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他们的症状有多困难。这项研究的主要目标是提高对癌症早期诊断障碍的理解，采取干预措施，帮助医生和患者更有效地沟通，最终实现早期癌症诊断。

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.