Delayed Cancer Diagnosis…and how to avoid it (possibly)
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Delayed Cancer Diagnosis…and how to avoid it (possibly)
Barnsley GP Training Scheme, 2013
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• To understand the concept of “delayed diagnosis” (with regards Cancer)
• To identify the causes of delayed cancer diagnoses
• To identify tools that can help you as a clinican improve your detection of cancer
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294,000 people will be diagnosed with cancer andaround 155,000 will die from cancer every year
http://info.cancerresearchuk.org/cancerstats/incidence/#mortality
Leading cause of mortality in people under age of 75 http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/dh_081006
8-9 new cancer cases per 2000 patients (DoH, 2009)
• Examples of a delayed cancer diagnosis:– What is a delayed cancer diagnosis?– At what point in the “patient journey” was the delay?– Why did that occur?– What could be done/changed/instigated to avoid the delay?
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Definition of a delayed diagnosis (NPSA, 2010)
Delayed diagnosis in cancer is when someone who has
cancer:
• is not investigated or referred for investigation;or
• having been investigated, is not diagnosed at the time of the investigation;or
• is diagnosed incorrectly;or
• where a positive test result or diagnosis is not communicated effectively to a clinician with
• The ability to act on the information;or
• where a positive test result or diagnosis is not acted upon and treatment commenced as appropriate.
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i.e. US – GPs !! “mis-diagnosis and insufficient examination most common themes (Mitchell, 2008)
Hansen’s model
Appraisal: delay in symptom interpretation may account for up to 60 % of total cancer delay in Breast/Gynae cases (Anderson, 1995)
Behavioural: delay in making an appt; Cancer was No 1 Fear ahead of MIs, Alzhemier’s and Terrorism (CRUK, 2007)
Scheduling: delay between making appt and being seen
Pathology 41%
Radiology 12%
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26%
Cancellations 15%
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Only 11% of patients referred with suspected Cancer = Cancer
Audit PGP, all Cancer dx May 2010 – May 2011 = 58 cases
14% Routine (5/8 potentially 2WW)
30% 2WW
12% Emergency (only 2/7 potentially 2WW)
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Always our fault…
• Types of Patient Safety Incidents:
– Diagnostics
• Pathology 41%
• Radiology 12%
– Communications 26%
– Cancellations 15%
– Clinical Assessments 5%
– Waiting Lists <1%
• Key issues raised by “stakeholder meetings”:
– Communication
– Clinical assessment and management
– Cultural issues (patients assuming a “passive” role)
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MDU• More than 50 % claims settled against GPs were
for delayed diagnosis
• Major risk group was Cancers:– Breast 22%– Bowel 14%– Cervical 13% – Skin 8%
• Causes:– Failure to examine patient properly– Inadequate f/u arrangements– Lack of appropriate investigations– Dysfunctional communication
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Tools that may help…
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• Audit and SEA audits– ENT malignancy audit,10 yrs, 5 malignancies, 39-320 days for
diagnosis (average 130 days)
• Other risk tools
– http://qcancer.org/
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Take home messages…
• What are yours?
• Mine:– Communicate effectively (with patients and
with team members ie receptionists/secretaries)– Examine appropriately and thoroughly– Use the appropriate investigations and do not
falsely reassure yourself with “normal” results– SEAs when necessary– Use the guidelines
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SH T
HA ENS