Children's Health Center, Armon Tower, Clalit Health Services, Haifa, Israel.
Cancer Epidemiol. 2011 Feb;35(1):83-9. doi: 10.1016/j.canep.2010.07.009. Epub 2010 Aug 3.
We evaluated the roles of the doctor and the medical system in Israel in the diagnostic delay of childhood malignancies.
We investigated the factors affecting the delay in the diagnosis of childhood malignancies in 315 children with solid malignancies, diagnosed and treated in Rambam Medical Center (RMC), between 1993 and 2001. Those factors were divided into two groups: 'Healthcare-system-related parameters', (factors directly related to the medical system), and 'Patient-related parameters' (factors that are not part of the medical system, but directly affect medical judgment and decisions, including factors related to the tumor). We also took into consideration epidemiological, social, and medical issues.
The main 'Healthcare-system-related parameters', which were found to influence the delay in diagnosis, were the type of medical authority that was initially consulted; the specialty of the first doctor; the number of additional doctors whom the child had visited, and the number of times the child had visited the first doctor. The main 'Patient-related parameters' found to have an impact on the delay in diagnosis were the age of the child, the tumor type, and the presenting symptom.
The education and awareness of doctors at the primary healthcare clinics must be improved. We suggest ways of improving the approach of doctors and managing a child with a suspected malignancy.
我们评估了以色列医生和医疗体系在儿童恶性肿瘤诊断延迟中的作用。
我们调查了 1993 年至 2001 年在 Rambam 医疗中心（RMC）诊断和治疗的 315 名实体恶性肿瘤儿童中，影响儿童恶性肿瘤诊断延迟的因素。这些因素分为两组：“医疗体系相关参数”（与医疗体系直接相关的因素）和“患者相关参数”（不属于医疗体系但直接影响医疗判断和决策的因素，包括与肿瘤相关的因素）。我们还考虑了流行病学、社会和医学问题。
主要的“医疗体系相关参数”，即最初咨询的医疗权威类型、首诊医生的专业、儿童就诊的额外医生数量以及儿童就诊首诊医生的次数，被发现会影响诊断的延迟。发现对诊断延迟有影响的主要“患者相关参数”是儿童的年龄、肿瘤类型和首发症状。
必须提高初级保健诊所医生的教育和意识。我们建议改进医生的方法和管理疑似恶性肿瘤儿童的方法。
