Appraisal Delay and Disparities in Timely Cancer Diagnosis

描述（由申请人提供）：少数种族/族裔的癌症发病率、患病率和死亡率差异已得到充分记录。尽管广泛和有针对性的癌症教育，筛查活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的筛查率较低，以及缺乏医疗保险造成的准入问题。然而，晚期发现癌症并不仅仅是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晚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照顾的症状时，会发生评估延迟。这可能最终导致癌症诊断的短期或长期延迟。我们认为，影响对症状的感知和解释的因素可能会阻碍少数种族和少数民族的早期癌症诊断，一旦患者实际向其医疗保健提供者呈现症状，这些因素可能会进一步阻碍医生和患者之间的沟通。本研究的目的是探讨评估延迟如何阻碍症状报告给他们的医疗保健提供者。我们还假设，这些患者在临床就诊期间将更难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的结肠癌患者，以确定他们对结肠癌症状的解释和报告，这些症状表明结肠癌的知己及其医疗保健提供者。将通过病历审查验证患者向其初级保健提供者报告症状与诊断之间的延迟时间（临床诊断延迟）。非裔美国人男性和女性以及白色男性和女性新诊断的结肠癌患者将进行比较。该研究的具体目标是：1）确定评估延迟和临床诊断延迟是否与种族/民族和性别相关，并检查随后调节这种关系的因素; 2）评估患者及其医疗保健提供者之间关于症状报告的沟通;和3）使用本研究的结果来阐明需要一个沟通研究使用直接观察的方法来确定是否和如何沟通的过程病人和初级保健提供者之间的沟通方式因种族和性别而异，当病人出现癌症诊断前症状时，他们与病人的沟通方式不同，从而导致诊断延误。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，更有效地将其传达给他们的医疗保健提供者，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.