Journal article
Patient- and system-related barriers for the earlier diagnosis of colorectal cancer
BMC family practice, Vol.10(1), pp.65-65
2009
DOI: 10.1186/1471-2296-10-65
PMCID: PMC2758830
PMID: 19754964
Abstract
Background: A cohort of colorectal cancer (CRC) patients represents an opportunity to study missed opportunities for earlier diagnosis.
Primary objective: To study the epidemiology of diagnostic delays and failures to offer/complete CRC screening.
Secondary objective: To identify system- and patient-related factors that may contribute to diagnostic delays or failures to offer/complete CRC screening.
Setting: Rural Veterans Administration (VA) Healthcare system.
Participants: CRC cases diagnosed within the VA between 1/1/2000 and 3/1/2007.
Data sources: progress notes, orders, and pathology, laboratory, and imaging results obtained between 1/1/1995 and 12/31/2007. Completed CRC screening was defined as a fecal occult blood test or flexible sigmoidoscopy (both within five years), or colonoscopy (within 10 years); delayed diagnosis was defined as a gap of more than six months between an abnormal test result and evidence of clinician response. A summary abstract of the antecedent clinical care for each patient was created by a certified gastroenterologist (GI), who jointly reviewed and coded the abstracts with a general internist (TW).
Results: The study population consisted of 150 CRC cases that met the inclusion criteria. The mean age was 69.04 (range 35-91); 99 (66%) were diagnosed due to symptoms; 61 cases (46%) had delays associated with system factors; of them, 57 (38% of the total) had delayed responses to abnormal findings. Fifteen of the cases (10%) had prompt symptom evaluations but received no CRC screening; no patient factors were identified as potentially contributing to the failure to screen/offer to screen. In total, 97 (65%) of the cases had missed opportunities for early diagnosis and 57 (38%) had patient factors that likely contributed to the diagnostic delay or apparent failure to screen/offer to screen.
Conclusion: Missed opportunities for earlier CRC diagnosis were frequent. Additional studies of clinical data management, focusing on following up abnormal findings, and offering/completing CRC screening, are needed.
Details
- Title: Subtitle
- Patient- and system-related barriers for the earlier diagnosis of colorectal cancer
- Creators
- Terry L Wahls - VA Iowa City Health Care System, Iowa City, Iowa, USAIka Peleg - Division of Gastroenterology, Department of Medicine, University of Oklahoma-Tulsa, Tulsa, Oklahoma, USA
- Resource Type
- Journal article
- Publication Details
- BMC family practice, Vol.10(1), pp.65-65
- DOI
- 10.1186/1471-2296-10-65
- PMID
- 19754964
- PMCID
- PMC2758830
- NLM abbreviation
- BMC Fam Pract
- ISSN
- 1471-2296
- eISSN
- 1471-2296
- Publisher
- BioMed Central
- Language
- English
- Date published
- 2009
- Academic Unit
- Neurology; Epidemiology; General Internal Medicine; Internal Medicine
- Record Identifier
- 9984020886802771
Metrics
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