Appraisal Delay and Disparities in Timely Cancer Diagnosis

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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.