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Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation.

Lyratzopoulos G, Vedsted P, Singh H - Br. J. Cancer (2015)

Bottom Line: Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis.Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda.We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.

View Article: PubMed Central - PubMed

Affiliation: 1] Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK [2] Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.

ABSTRACT
The diagnosis of cancer is a complex, multi-step process. In this paper, we highlight factors involved in missed opportunities to diagnose cancer more promptly in symptomatic patients and discuss responsible mechanisms and potential strategies to shorten intervals from presentation to diagnosis. Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis. They can occur in any of the three phases of the diagnostic process (initial diagnostic assessment; diagnostic test performance and interpretation; and diagnostic follow-up and coordination) and can involve patient, doctor/care team, and health-care system factors, often in combination. In this perspective article, we consider epidemiological 'signals' suggestive of missed opportunities and draw on evidence from retrospective case reviews of cancer patient cohorts to summarise factors that contribute to missed opportunities. Multi-disciplinary research targeting such factors is important to shorten diagnostic intervals post presentation. Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda. We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.

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A model for defining missed diagnostic opportunities. Adopted from Singh, 2014.
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fig1: A model for defining missed diagnostic opportunities. Adopted from Singh, 2014.

Mentions: It should be emphasised that not all missed opportunities or delays necessarily result in harm or poor patient outcomes and not all instances of delayed diagnosis are associated with missed opportunities (Figure 1; Singh, 2014). Missed opportunities may relate to any disease; for example, six out of seven patients subsequently diagnosed with chronic obstructive pulmonary disease are reported to have experienced missed opportunities, and very long diagnostic delays are reported among patients with ankylosing spondylitis (Hamilton et al, 2011; Jones et al, 2014). In this paper nonetheless we focus solely on patients with cancer who have sought medical help for their symptoms and exclude the consideration of potential opportunities for earlier presentation or participation in screening programmes.


Understanding missed opportunities for more timely diagnosis of cancer in symptomatic patients after presentation.

Lyratzopoulos G, Vedsted P, Singh H - Br. J. Cancer (2015)

A model for defining missed diagnostic opportunities. Adopted from Singh, 2014.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4385981&req=5

fig1: A model for defining missed diagnostic opportunities. Adopted from Singh, 2014.
Mentions: It should be emphasised that not all missed opportunities or delays necessarily result in harm or poor patient outcomes and not all instances of delayed diagnosis are associated with missed opportunities (Figure 1; Singh, 2014). Missed opportunities may relate to any disease; for example, six out of seven patients subsequently diagnosed with chronic obstructive pulmonary disease are reported to have experienced missed opportunities, and very long diagnostic delays are reported among patients with ankylosing spondylitis (Hamilton et al, 2011; Jones et al, 2014). In this paper nonetheless we focus solely on patients with cancer who have sought medical help for their symptoms and exclude the consideration of potential opportunities for earlier presentation or participation in screening programmes.

Bottom Line: Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis.Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda.We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.

View Article: PubMed Central - PubMed

Affiliation: 1] Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK [2] Department of Public Health and Primary Care, Cambridge Centre for Health Services Research, University of Cambridge, Institute of Public Health, Forvie Site, Robinson Way, Cambridge CB2 0SR, UK.

ABSTRACT
The diagnosis of cancer is a complex, multi-step process. In this paper, we highlight factors involved in missed opportunities to diagnose cancer more promptly in symptomatic patients and discuss responsible mechanisms and potential strategies to shorten intervals from presentation to diagnosis. Missed opportunities are instances in which post-hoc judgement indicates that alternative decisions or actions could have led to more timely diagnosis. They can occur in any of the three phases of the diagnostic process (initial diagnostic assessment; diagnostic test performance and interpretation; and diagnostic follow-up and coordination) and can involve patient, doctor/care team, and health-care system factors, often in combination. In this perspective article, we consider epidemiological 'signals' suggestive of missed opportunities and draw on evidence from retrospective case reviews of cancer patient cohorts to summarise factors that contribute to missed opportunities. Multi-disciplinary research targeting such factors is important to shorten diagnostic intervals post presentation. Insights from the fields of organisational and cognitive psychology, human factors science and informatics can be extremely valuable in this emerging research agenda. We provide a conceptual foundation for the development of future interventions to minimise the occurrence of missed opportunities in cancer diagnosis, enriching current approaches that chiefly focus on clinical decision support or on widening access to investigations.

Show MeSH
Related in: MedlinePlus