School of Dentistry, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
Department of Oncology, Cross Cancer Institute, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
PLoS One. 2022 Apr 26;17(4):e0266558. doi: 10.1371/journal.pone.0266558. eCollection 2022.
Oral cancer continues to be diagnosed in advanced stages, giving patients lower chances of survival. The objective of this study was to explore reasons for delayed diagnosis of oral cancer in Alberta. A retrospective qualitative design was implemented through seven steps suggested for conducting a narrative clinical document. Data was retrieved from the Alberta Cancer Registry database between 2005 and 2017. A sample of initial consultation notes (ICN) of oral and oropharyngeal cancer patients were identified through a purposeful sampling method and added to the study until saturation was achieved. A deductive analysis approach inspired by the model pathways to treatment health care provider (HCP) was employed. From the 34 ICN included in our analysis, five main categories were identified: appraisal interval, help-seeking interval, diagnosis interval, pre-treatment interval, and other contributing factors such as health-related behaviours, system delay, and tumor characteristics. These factors negatively contributed to early detection of oral and oropharyngeal cancers and affect treatment wait time with patients, providers, and the healthcare system. Patient's lack of awareness, provider's oversight and prolonged access to care were the main reasons of delay in cancer diagnosis and management in our study. A sustainable plan for public awareness interventions and implementation of a solid curriculum for medical and dental students is needed to enhance their related knowledge, competence in clinical judgement, and treatment managements.
口腔癌仍被诊断为晚期,这降低了患者的生存机会。本研究旨在探讨艾伯塔省口腔癌诊断延迟的原因。通过对叙述性临床文档进行的七个步骤的建议,实施了回顾性定性设计。数据是从 2005 年至 2017 年的艾伯塔省癌症登记处数据库中检索出来的。通过有针对性的抽样方法,确定了口腔和口咽癌患者初始咨询记录(ICN)的样本,并将其添加到研究中,直到达到饱和状态。采用了一种受治疗保健提供者(HCP)途径模型启发的演绎分析方法。从我们的分析中包含的 34 份 ICN 中,确定了五个主要类别:评估间隔、寻求帮助间隔、诊断间隔、治疗前间隔,以及健康相关行为、系统延迟和肿瘤特征等其他因素。这些因素对口腔和口咽癌的早期发现产生负面影响,并影响患者、提供者和医疗保健系统的治疗等待时间。在我们的研究中,患者缺乏意识、提供者的疏忽和获得医疗护理的时间延长是癌症诊断和治疗延迟的主要原因。需要制定可持续的公众意识干预计划,并为医学生和牙科学生实施扎实的课程,以提高他们在相关知识、临床判断能力和治疗管理方面的能力。