Appraisal Delay and Disparities in Timely Cancer Diagnosis

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。当患者无法识别或解释他们正在经历的需要医疗护理的症状时，就会出现评估延迟。这最终可能导致癌症诊断的短期或长期延误。我们假设，影响症状感知和解释的因素可能会阻碍种族和少数民族早期癌症诊断，这些因素可能会进一步阻碍医生和患者之间的沟通，一旦患者实际向他们的医疗保健提供者提出症状。本研究的目的是检查评估延迟如何阻碍症状报告给他们的卫生保健提供者。我们还假设这些患者在临床遇到时将更难以有效地将这些症状传达给他们的医生。为了实现这一目标，我们将使用半结构化访谈工具采访最近诊断出结肠癌的患者，以确定他们对知己及其医疗保健提供者指示结肠癌症状的解释和报告。患者向其初级保健提供者报告症状和诊断之间的时间延迟（临床诊断延迟）将通过图表审查来验证。非裔美国人男性和女性以及白人男性和女性新诊断的结肠癌患者将进行比较。该研究的具体目的是：1)确定评估延迟和临床诊断延迟是否与种族/民族和性别有关，并检查随后调节这种关系的因素；2)评估患者与医护人员关于症状报告的沟通；3)利用本研究的结果，澄清是否需要采用直接观察的方法进行沟通研究，以确定当患者出现癌症诊断前症状时，患者与初级保健提供者之间的沟通过程是否以及如何通过不同种族和性别的患者进行不同的沟通而导致诊断延迟。公共卫生相关性：该项目可以提高对癌症早期诊断障碍的理解，并导致干预措施，帮助患者了解他们的症状，更有效地与他们的卫生保健提供者沟通，并最终导致早期癌症诊断和更好的结果。

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. Appraisal delay occurs when patients fail to recognize or interpret symptoms they are experiencing as requiring medical attention. This can ultimately result in short or lengthy delays in making a diagnosis of cancer. We posit that factors that influence the perception and interpretation of symptoms may impede an earlier cancer diagnosis in racial and ethnic minorities and that these factors may further hamper communication between physicians and patients once patients actually present symptoms to their health care provider. The goal of this study is to examine how appraisal delay impedes the reporting of symptoms to their health care providers. We also hypothesize that these patients will have more difficulty effectively communicating these symptoms to their physicians during the clinical encounter. To accomplish this goal, we will interview recently diagnosed colon cancer patients using a semi-structured interview instrument to identify their interpretations and reporting of the symptoms that were indicative of colon cancer to confidantes and their health care providers. Time to delay between patient report of symptoms to their primary care providers and diagnosis (clinical diagnostic delay) will be validated by chart review. African- American men and women and white male and female patients with newly diagnosed colon cancer will be compared. The study's specific aims are: 1) Determine if appraisal delay and clinical diagnostic delay are associated with race/ethnicity and gender and examine factors that subsequently moderate this relationship; 2) Assess the communications between patients and their health care providers about symptom reporting; and 3) Use the results of this study to clarify the need for a communication study using direct observation methods to determine whether and how the communication process between patients and primary care providers contribute to diagnostic delay by communicating differently with patients by race and gender when they present pre-diagnosis symptoms of cancer. PUBLIC HEALTH RELEVANCE: This project can improve understanding of the barriers to early diagnosis of cancer and lead to interventions that can help patients understand their symptoms, communicate them more effectively to their health care providers, and ultimately lead to earlier cancer diagnoses and better outcomes.