Process of Care Failures in Breast Cancer Diagnosis
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Process of care failures may contribute to diagnostic errors in breast cancer care.
To identify patient- and provider-related process of care failures in breast cancer screening and follow-up in a non-claims-based cohort.
Retrospective chart review of a cohort of patients referred to two Boston cancer centers with new breast cancer diagnoses between January 1, 1999 and December 31, 2004.
We identified 2,275 women who reported ≥90 days between symptom onset and breast cancer diagnosis or presentation with at least stage II disease. We then selected the 340 (14.9%) whose physicians shared an electronic medical record. We excluded 238 subjects whose records were insufficient for review, yielding a final cohort of 102 patients.
We tabulated the number and types of process of care failures and examined risk factors using bivariate analyses and multivariable Poisson regression.
Twenty-six of 102 patients experienced ≥1 process of care failure. The most common failures occurred when physicians failed to perform an adequate physical examination, when patients failed to seek care, and when diagnostic or laboratory tests were ordered but patients failed to complete them. Failures were attributed in similar numbers to provider- and patient-related factors (n = 30 vs. n = 25, respectively). Process of care failures were more likely when the patient’s primary care physician was male (IRR 2.8, 95% CI 1.2 to 6.5) and when the patient was non-white (IRR 2.8, 95% CI 1.4 to 5.7).
Process failures were common in this patient cohort, with both clinicians and patients contributing to breakdowns in the diagnostic process.
- Schaefer, M (2002) Overview of CRICO cancer-related diagnosis claims 1992–2001. RMF Forum 22: pp. 4-9
- Gandhi, TK, Kachalia, A, Thomas, EJ (2006) Missed and delayed diagnoses in the ambulatory setting: a study of closed malpractice claims. Ann Intern Med 145: pp. 488-496
- Richards, MA, Westcombe, AM, Love, SB, Littlejohns, P, Ramirez, AJ (1999) Influence of delay on survival in patients with breast cancer: a systematic review. Lancet 353: pp. 1119-1126 CrossRef
- Phillips, RL, Bartholomew, LA, Dovey, SM, Fryer, GE, Miyoshi, TJ, Green, LA (2004) Learning from malpractice claims about negligent, adverse events in primary care in the United States. Qual Saf Health Care 13: pp. 121-126 CrossRef
- Chandra A, Nundy S, Seabury SA. The growth of physician medical malpractice payments: evidence from the national practitioner data bank. Health Aff (Millwood). 2005;Suppl Web Exclusives: W5-40–W5-49.
- Kachalia, A, Gandhi, TK, Puopolo, AL (2007) Missed and delayed diagnoses in the emergency department: a study of closed malpractice claims from four liability insurers. Ann Emerg Med 49: pp. 196-205 CrossRef
- Rogers, SO, Gawande, AA, Kwaan, M (2006) Analysis of surgical errors in closed malpractice claims at four liability insurers. Surgery 140: pp. 25-33 CrossRef
- Studdert, DM, Thomas, EJ, Burstin, HR, Zbar, BI, Orav, EJ, Brennan, TA (2000) Negligent care and malpractice claiming behavior in Utah and Colorado. Med Care 38: pp. 250-260 CrossRef
- Burstin, HR, Johnson, WG, Lipsitz, SR, Brennan, TA (1993) Do the poor sue more? A case-control study of malpractice claims and socioeconomic status. JAMA 270: pp. 1697-1701 CrossRef
- Thomas, EJ, Studdert, DM, Burstin, HR (2000) Incidence and types of adverse events and negligent care in Utah and Colorado. Med Care 38: pp. 261-271 CrossRef
- Kreuter, MW, Strecher, VJ, Harris, R, Kobrin, SC, Skinner, CS (1995) Are patients of women physicians screened more aggressively?. J Gen Intern Med 10: pp. 119-125 CrossRef
- Lurie, N, Slater, J, McGovern, P, Ekstrum, J, Quam, L, Margolis, K (1993) Preventative care for women—does the sex of the physician matter?. N Engl J Med 329: pp. 478-482 CrossRef
- Lurie, N, Margolis, KL, McGovern, PG, Mink, PJ, Slater, JS (1997) Why do patients of female physicians have higher rates of breast and cervical cancer screening?. J Gen Intern Med 12: pp. 34-43 CrossRef
- Kösters JP, Gøtzsche PC. Regular self-examination or clinical examination for early detection of breast cancer. Cochrane Database of Systematic Reviews 2003, Issue 2. Art. No.: CD003373. doi:10.1002/14651858.CD003373.
- Weinmann, S, Taplin, SH, Gilbert, J (2005) Characteristics of women refusing follow-up for tests or symptoms suggestive of breast cancer. J Natl Cancer Inst 35: pp. 33-38
- Remennick, L (2006) The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J 12: pp. 103-110 CrossRef
- Gorin, SS, Heck, JE, Cheng, B, Smith, SJ (2006) Delays in breast cancer diagnosis and treatment by racial/ethnic group. Arch Intern Med 166: pp. 2244-2252 CrossRef
- Taplin, SH, Ichikawa, L, Yood, Mu, Manos, MM, Geiger, AM, Weinmann, S (2004) Reason for late-stage breast cancer: absence of screening or detection, or breakdown in follow-up?. J Natl Cancer Inst 96: pp. 1518-1527 CrossRef
- Halliday, T, Taira, DA, Davis, J, Chan, H (2007) Socioeconomic disparities in breast cancer screening in Hawaii. Prev Chronic Dis 4: pp. 1-9
- Ives, DG, Lave, JR, Traven, ND, Schulz, R, Kuller, LH (1996) Mammography and pap smear use by older rural women. Public Health Rep 111: pp. 244-250
- Use of mammography services by women aged ≥65 years in Medicare—United States, 1991–1993. MMWR Morb Mortal Wkly Rep 44: pp. 777-781
- Wells, K, Roetzheim, RG (2007) Health disparities in receipt of screening mammography in Latinas: a critical review of recent literature. Cancer Control 14: pp. 369-379
- Kaplan, CP, Crane, LA, Stewart, S, Juarez-Reyes, M (2004) Factors affecting follow-up among low-income women with breast abnormalities. J Womens Health 13: pp. 195-206 CrossRef
- Caplan, LS, May, DS, Richardson, LC (2000) Time to diagnosis and treatment of breast cancer: results from the National Breast and Cervical Cancer Early Detection Program, 1991–1995. Am J Public Health 90: pp. 130-134 CrossRef
- Tartter, P, Pace, D, Frost, M, Bernstein, JL (1999) Delay in diagnosis of breast cancer. Ann Surg 229: pp. 91-96 CrossRef
- Sainsbury, R, Johnston, C, Haward, B (1999) Effect on survival of delays in referral of patients with breast-cancer symptoms: a retrospective analysis. Lancet 353: pp. 1132-1135 CrossRef
- Hardin, C, Pommier, S, Pommier, RF (2006) The relationships among clinician delay of diagnosis of breast cancer and tumor size, nodal status, and stage. Am J Surg 192: pp. 506-508 CrossRef
- Afzelius, P, Zedeler, K, Sommer, H, Mouridsen, HT, Blichert-Toft, M (1994) Patient’s and doctor’s delay in primary breast cancer: Prognostic implications. Acta Oncol 33: pp. 345-351 CrossRef
- Arndt, V, Sturmer, T, Stegmaier, C, Ziegler, H, Dhom, G, Brenner, H (2002) Patient delay and stage of diagnosis among breast cancer patients in Germany—a population-based study. Br J Cancer 86: pp. 1034-1040 CrossRef
- Hanna, D, Griswold, P, Leape, LL, Bates, DW (2005) Communicating critical test results: safe practice recommendations. Jt Comm J Qual Patient Saf 31: pp. 68-80
- Ell, K, Vourlekis, B, Lee, PJ, Xie, B (2007) Patient navigation and case management following an abnormal mammogram: a randomized clinical trial. Prev Med 44: pp. 26-33 CrossRef
- Heyding, RK, Cheung, AM, Mocarski, EJ, Moineddin, R, Hwang, SW (2005) A community-based intervention to increase screening mammography among disadvantaged women at an inner-city drop-in center. Women Health 41: pp. 21-31 CrossRef
- Localio, AR, Lawthers, AG, Brennan, TA, Laird, NM, Hebert, LE, Peterson, LM, Newhouse, JP, Weiler, PC, Hiatt, HH (1991) Relation between malpractice claims and adverse events due to negligence. Results of the Harvard Medical Practice Study III. N Engl J Med 325: pp. 245-251
- Brennan, TA, Localio, AR, Leape, LL (1990) Identification of adverse events occurring during hospitalization. A cross-sectional study of litigation, quality assurance, and medical records at two teaching hospitals. Ann Intern Med 112: pp. 221-226
- Leape, LL, Brennan, TA, Laird, N (1991) The nature of adverse events in hospitalized patients. Results of the Harvard Medical Practice Study II. N Engl J Med 324: pp. 377-384
- Process of Care Failures in Breast Cancer Diagnosis
Journal of General Internal Medicine
Volume 24, Issue 6 , pp 702-709
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- breast cancer
- diagnostic errors
- medical errors
- quality of health care
- Industry Sectors
- Author Affiliations
- 1. Center for Patient Safety, Dana-Farber Cancer Institute, 44 Binney St., Boston, MA, 02115, USA
- 2. Harvard Medical School, Boston, MA, USA
- 3. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA
- 4. Department of Ambulatory Care and Prevention, Harvard Medical School, Boston, MA, USA
- 5. Harvard Vanguard Medical Associates, Boston, MA, USA
- 6. Melbourne Law School, University of Melbourne, Melbourne, Australia
- 7. Risk Management Foundation of the Harvard Medical Institutions, Boston, MA, USA