Faugno Elena, Galbraith Alison A, Walsh Kathleen, Maglione Paul J, Farmer Jocelyn R, Ong Mei-Sing
Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts, USA.
BMJ Qual Saf. 2025 Feb 19;34(3):190-200. doi: 10.1136/bmjqs-2024-017506.
Diagnostic delay is a pervasive patient safety problem that disproportionately affects historically underserved populations. We aim to systematically examine and synthesise published qualitative studies on patient experiences with diagnostic delay among historically underserved racial and ethnic populations.
PubMed.
Primary qualitative studies detailing patient or caregiver-reported accounts of delay in the diagnosis of a disease among underserved racial and ethnic populations; conducted in the USA; published in English in a peer-reviewed journal (years 2012-2022); study cohort composed of >50% non-white racial and ethnic populations.
Primary outcomes were barriers to timely diagnosis of a disease. Screening and thematic abstraction were performed independently by two investigators, and data were synthesised using the 'Model of Pathways to Treatment' conceptual framework.
Sixteen studies from multiple clinical domains were included. Barriers to timely diagnosis emerged at the socioeconomic and sociocultural level (low health literacy, distrust in healthcare systems, healthcare avoidance, cultural and linguistic barriers), provider level (cognitive biases, breakdown in patient-provider communication, lack of disease knowledge) and health systems level (inequity in organisational health literacy, administrative barriers, fragmented care environment and a lack of organisational cultural competence). None of the existing studies explored diagnostic disparities among Asian Americans/Pacific Islanders, and few examined chronic conditions known to disproportionately affect historically underserved populations.
Historically underserved racial and ethnic patients encountered many challenges throughout their diagnostic journey. Systemic strategies are needed to address and prevent diagnostic disparities.
诊断延迟是一个普遍存在的患者安全问题，对历史上服务不足的人群影响尤为严重。我们旨在系统地审查和综合已发表的关于历史上服务不足的种族和族裔人群诊断延迟患者经历的定性研究。
PubMed。
主要定性研究，详细描述了服务不足的种族和族裔人群中患者或护理人员报告的疾病诊断延迟情况；在美国进行；以英文发表在同行评审期刊上（2012 - 2022年）；研究队列中超过50%为非白种种族和族裔人群。
主要结果是疾病及时诊断的障碍。由两名研究人员独立进行筛选和主题提炼，并使用“治疗途径模型”概念框架对数据进行综合分析。
纳入了来自多个临床领域的16项研究。在社会经济和社会文化层面（健康素养低、对医疗系统不信任、避免就医、文化和语言障碍）、医疗服务提供者层面（认知偏差、医患沟通中断、缺乏疾病知识）以及卫生系统层面（组织健康素养不平等、行政障碍、护理环境碎片化以及缺乏组织文化能力）出现了及时诊断的障碍。现有研究均未探讨亚裔美国人/太平洋岛民之间的诊断差异，很少有研究考察已知对历史上服务不足人群影响尤为严重的慢性病。
历史上服务不足的种族和族裔患者在整个诊断过程中面临许多挑战。需要系统性策略来解决和预防诊断差异。
