Interventions to improve timely cancer diagnosis: an integrative review.

IF 2.2 Q2 MEDICINE, GENERAL & INTERNAL Diagnosis Pub Date : 2024-10-18 DOI:10.1515/dx-2024-0113
Mark L Graber, Bradford D Winters, Roni Matin, Rosann T Cholankeril, Daniel R Murphy, Hardeep Singh, Andrea Bradford
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Abstract

Cancer will affect more than one in three U.S. residents in their lifetime, and although the diagnosis will be made efficiently in most of these cases, roughly one in five patients will experience a delayed or missed diagnosis. In this integrative review, we focus on missed opportunities in the diagnosis of breast, lung, and colorectal cancer in the ambulatory care environment. From a review of 493 publications, we summarize the current evidence regarding the contributing factors to missed or delayed cancer diagnosis in ambulatory care, as well as evidence to support possible strategies for intervention. Cancer diagnoses are made after follow-up of a positive screening test or an incidental finding, or most commonly, by following up and clarifying non-specific initial presentations to primary care. Breakdowns and delays are unacceptably common in each of these pathways, representing failures to follow-up on abnormal test results, incidental findings, non-specific symptoms, or consults. Interventions aimed at 'closing the loop' represent an opportunity to improve the timeliness of cancer diagnosis and reduce the harm from diagnostic errors. Improving patient engagement, using 'safety netting,' and taking advantage of the functionality offered through health information technology are all viable options to address these problems.

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改善癌症及时诊断的干预措施:综合综述。
每三名美国居民中就有一人会在一生中受到癌症的影响,尽管在大多数情况下都能得到有效的诊断,但大约有五分之一的患者会出现诊断延迟或漏诊的情况。在这篇综合综述中,我们将重点关注门诊环境中乳腺癌、肺癌和结直肠癌诊断的漏诊情况。通过对 493 篇文献的综述,我们总结了有关非住院医疗环境中癌症漏诊或延迟诊断诱因的现有证据,以及支持可能的干预策略的证据。癌症诊断是在对筛查阳性结果或偶然发现进行随访后做出的,或者最常见的是通过对初级保健中的非特异性初步病例进行随访和澄清后做出的。在上述每种途径中,中断和延误都是不可接受的普遍现象,即未能跟进异常检测结果、偶然发现、非特异性症状或咨询。以 "闭环 "为目标的干预措施为提高癌症诊断的及时性和减少诊断错误造成的伤害提供了机会。提高患者参与度、使用 "安全网 "以及利用医疗信息技术提供的功能都是解决这些问题的可行方案。
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来源期刊
Diagnosis
Diagnosis MEDICINE, GENERAL & INTERNAL-
CiteScore
7.20
自引率
5.70%
发文量
41
期刊介绍: Diagnosis focuses on how diagnosis can be advanced, how it is taught, and how and why it can fail, leading to diagnostic errors. The journal welcomes both fundamental and applied works, improvement initiatives, opinions, and debates to encourage new thinking on improving this critical aspect of healthcare quality.  Topics: -Factors that promote diagnostic quality and safety -Clinical reasoning -Diagnostic errors in medicine -The factors that contribute to diagnostic error: human factors, cognitive issues, and system-related breakdowns -Improving the value of diagnosis – eliminating waste and unnecessary testing -How culture and removing blame promote awareness of diagnostic errors -Training and education related to clinical reasoning and diagnostic skills -Advances in laboratory testing and imaging that improve diagnostic capability -Local, national and international initiatives to reduce diagnostic error
期刊最新文献
Bayesian intelligence for medical diagnosis: a pilot study on patient disposition for emergency medicine chest pain. Bringing team science to the ambulatory diagnostic process: how do patients and clinicians develop shared mental models? From stable teamwork to dynamic teaming in the ambulatory care diagnostic process. Interventions to improve timely cancer diagnosis: an integrative review. Implementation of a bundle to improve diagnosis in hospitalized patients: lessons learned.
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