Reducing Missed And Delayed Diagnoses In Cancer: Lessons From Aviation

描述（由申请人提供）：该奖项的目的是为申请人提供必要的经验、指导和知识，使其成为癌症诊断错误领域的独立卫生服务研究人员。诊断错误可能是初级保健中最常见的错误类型，也是最昂贵的。漏诊和延迟的癌症诊断尤其频繁、有害且代价高昂。人们对癌症诊断中的错误知之甚少，也很难进行研究。虽然诊断错误已被证明有系统和认知的起源，但没有一个综合的医学诊断问题解决理论来解决这两种类型的因素。然而，航空安全研究中使用的态势感知框架包含了飞行员决策错误的认知和系统根源，也可能为改进诊断过程提供解决方案。态势感知先于有效决策，并且对有效决策至关重要，是正确诊断概念化的关键因素。研究目标是使用态势感知框架，该框架具有解决医疗决策错误的系统和认知根源的潜力，以确定错过和延迟乳腺癌，肺癌和结肠癌诊断的关键决定因素。总体假设是，态势感知框架可用于识别诊断过程中的主要认知和系统漏洞，并建议未来的改进目标。在前期工作中，申请人已经使用这个框架来研究癌症诊断决策的过程。利用来自德克萨斯医学中心多个机构的跨学科资源、来自美国国家航空航天局的合作专业知识以及通过美国国家癌症研究所资助的联盟提供的临床场景，具体目标是：目标1：使用态势感知框架回顾性地识别导致癌症诊断错误的主要系统因素。目的2：在模拟环境中使用情境感知框架前瞻性地识别癌症相关诊断决策中的主要认知错误。目标3;前瞻性研究认知和系统因素及其相互作用在真实临床环境中对癌症诊断情境感知的影响。申请人具有丰富的临床经验，目前正在通过美国国立卫生研究院资助的K30项目获得基本的研究技能。为了实现理解和减少诊断错误的目标，他需要先进的研究技能和特定内容学科的指导培训。一个高素质的跨学科咨询团队将监督培训，包括指导研究、正式课程、指导阅读和研讨会。拟议的活动将为减少癌症诊断错误提供多学科基础，并将为申请人提供在专注于癌症诊断的健康结果研究事业中实现独立所需的经验和技能。

DESCRIPTION (provided by applicant): The objective of this award is to provide the applicant with the experience, mentoring and knowledge necessary to become an independent health services researcher in the field of diagnostic errors in cancer. Diagnostic errors are likely the most common type of error in primary care and are the most expensive. Missed and delayed cancer diagnoses are particularly frequent, harmful and costly. Errors in cancer diagnosis are poorly understood and difficult to study. Although diagnostic errors have been shown to have both systems and cognitive origins, there is no comprehensive theory of medical diagnostic problem-solving that addresses both types of factors. However, the situational awareness framework used in aviation safety research encompasses cognitive and system origins of pilots' decision-making errors and may offer solutions to improving the diagnostic process as well. Situational awareness precedes and is critical to effective decision-making, a key element in conceptualization of a correct diagnosis. The research goal is to use the situational awareness framework, which has the potential to address both systems and cognitive origins of medical decision-making errors, to identify key determinants of missed and delayed breast, lung and colon cancer diagnoses. The overall hypothesis is that the situational awareness framework can be used to identify the major cognitive and systems vulnerabilities in the diagnostic process and to suggest future targets for improvement. In preliminary work, the applicant has used this framework to study the process of diagnostic decision-making in cancer. Taking advantage of interdisciplinary resources from several institutions in the Texas Medical Center, collaborative expertise from the National Aeronautics and Space Administration, and clinical scenarios available through a National Cancer Institute-funded consortium, the specific aims are: Aim 1: To use the situational awareness framework to retrospectively identify the major system factors that lead to diagnostic errors in cancer. Aim 2: To use the situational awareness framework in a simulated setting to prospectively identify the major cognitive errors in cancer-related diagnostic decision-making. Aim 3; To study prospectively the effects of cognitive and system factors and their interplay on situational awareness in diagnosis of cancers in real clinical settings. The applicant has extensive clinical experience and is currently obtaining basic research skills through an NIH-funded K30 program. To achieve his goal of understanding and reducing diagnostic errors he needs advanced research skills and mentored training in specific content disciplines. A highly qualified interdisciplinary advisory team will supervise training that will include mentored research, formal coursework, directed readings and seminars. The proposed activities will provide a multidisciplinary foundation to reduce diagnostic errors in cancer and will provide the applicant with the experiences and skills he needs to achieve independence in a health outcomes research career focused on cancer diagnoses.