Agreement between patients and general practitioners on quality deviations during the cancer diagnostic pathway and associations with time to diagnosis

Autor: Mette Sandager, Henry Jensen, Cecilie Dyg Sperling, Peter Vedsted
Rok vydání: 2015
Předmět:
Zdroj: Jensen, H, Sperling, C, Sandager, M & Vedsted, P 2015, ' Agreement between patients and general practitioners on quality deviations during the cancer diagnostic pathway and associations with time to diagnosis ', Family Practice . https://doi.org/10.1093/fampra/cmv021
ISSN: 1460-2229
0263-2136
DOI: 10.1093/fampra/cmv021
Popis: Dette studie undersøger forskelle mellem patienters og lægers opfattelse af kvalitetsafvigelser i kræftforløb: grad af enighed, antal og type af afvigelser samt indflydelse på det diagnostiske interval. Resultaterne viser, at både patienter og læger angiver kvalitetsafvigelser i 29 % af de undersøgte forløb. Selvom de er enige i antallet af forløb med afvigelser, er de mindre enige om, hvilke forløb det drejer sig om. Kvalitetsafvigelser var stærkest associeret med tiden til diagnose, når lægen angav en kvalitetsafvigelse, og patientens angivelse styrkede denne sammenhæng en smule. Resultaterne viser, at patienter og læger opfatter kvalitetsafvigelser forskelligt, og at den praktiserende læge synes at være den bedste informationskilde, hvis sundhedsvæsenet ønsker at identificere og reducere de kvalitetsafvigelser, der er relateret til en forlænget afklarings- og udredningstid. Det er også i tråd med tidligere studer, der viser, at lægen er en velegnet kilde til studier af kvalitetsafvigelser og sammenhængen med kliniske faktorer. Studiet bygger på data fra 2,177 patientforløb fra 2010. BACKGROUND: High quality and minimal delay are crucial and anticipated elements in the diagnostic cancer pathway as delay in the diagnosis may worsen the prognosis and cause lower patient satisfaction.OBJECTIVE: The aim of this study was to describe agreement in reported quality deviations (QDs) between general practitioners (GPs) and cancer patients during the diagnostic pathway in primary care and to estimate the association between length of diagnostic interval and level of agreement on reported QDs.METHODS: The study was carried out as a Danish cross-sectional study of incident cancer patients identified in the Danish National Patient Registry. Data were collected by independent questionnaires from patients (response rate: 53.0%) and their GPs (response rate: 73.8%), and 2177 pairs of questionnaires were subsequently combined. Agreement between GP- and patient-reported QDs was estimated using Cohen's Kappa, whereas the association between level of agreement and time to diagnosis was estimated using quantile regression.RESULTS: Patients reported QDs in 29.0% and GPs in 28.5% of the cases, but agreed only slightly on QD presence (Kappas between -0.08 and 0.26). Agreement on 'QD presence' was associated with a 54-day (95%CI: 44-64) longer time to diagnosis than agreement on 'no QD presence'. The association with a longer diagnostic interval was stronger when only GP reported a QD the association than when only patient reported a QD.CONCLUSION: Included GPs and patients agreed only slightly on QD presence although they reported the same amount of QDs; this suggests that GPs and patients see QDs as two different concepts. QD presence had a stronger impact on time to diagnosis when reported by the GP (alone or in agreement with the patient) than when reported by the patient alone. The GP may thus be the most important source of information on QD and diagnostic interval, while the patient information tends to underpin this assessment.
Databáze: OpenAIRE
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