title: Investigating Patient and Physician Delays in the Diagnosis of Head and Neck Cancers: a Canadian Perspective.
abstract: Diagnostic delays for head and neck cancer (HNC) patients are common. Patients often disregard symptoms for long periods before seeking help, and some family physicians may not be alert to the warning symptoms and signs of HNCs. This study evaluated the factors associated with length of delays in the diagnosis of HNCs in a Canadian population. This was a mixed-method study consisting of patient interviews and surveys in an academic health center. A questionnaire requesting demographic and disease information was completed by HNC patients followed by a 30 min semi-structured interview in a private setting. Interviews were audio recorded, transcribed, anonymized, and descriptively coded for emergent themes. Twenty-eight head and neck cancer patients participated in the study. More patients experienced physician delay (71 %) than patient delay (36 %). The median physician delay and patient delay were 108 and 31 days, respectively. Two main themes regarding these delays were (1) physician lack of knowledge and (2) lack of patient awareness. Results indicate that physician delay needs to be focused on compared to patient delay, as it is more common and has longer delays. More comprehensive training in head and neck clinical examination skills during undergraduate and residency training is recommended to reduce physician delay. Patient delay could be targeted by public education programs via both physicians and dentists.
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Suite 413, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: Jonghun John
authors.initials: JJ
authors.lastname: Lee
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Suite 413, Toronto, Ontario, M5G 1X5, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Dhepnorrarat
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
authors.forename: Joyce
authors.initials: J
authors.lastname: Nyhof-Young
authors.affiliation: Department of Otolaryngology - Head & Neck Surgery, University of Toronto, Mount Sinai Hospital, 600 University Avenue, Suite 413, Toronto, Ontario, M5G 1X5, Canada. iwitterick@mtsinai.on.ca.
authors.forename: Ian
authors.initials: I
authors.lastname: Witterick
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis*; D002983:Clinical Competence; D057210:Delayed Diagnosis; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010820:Physicians; D011379:Prognosis
keywords: Cancer; Delay; Diagnosis; Head and neck