Patients’ Experiences of a Sarcoma Diagnosis: A Process Mapping Exercise of Diagnostic Pathways
Abstract
:Simple Summary
Abstract
1. Introduction
2. Materials and Methods
2.1. Data Collection
2.2. Ethical Approvals
2.3. Secondary Data Analysis
2.4. Process Mapping: Data and Appointment Log Construction
- Patient ID: corresponds to the patient case number from Celonis.
- Activity: refers to the type of appointment involved in patients’ interactions with clinical services.
- Timestamp: refers to the date the first symptom was noticed by the patient.
- Age cohort: age at time of diagnosis.
- Gender: patients’ declared gender.
- Symptom: nature of initial symptom(s).
- Misdiagnosis: if the patient experienced a medical misdiagnosis.
- Final Diagnosis: the final sarcoma diagnosis received by the patient.
- Diagnosis type: soft tissue, bone, head and neck (H and N) and Gastrointestinal Stromal Tumours (GIST). Clinically, H and N and GIST behave distinctly, hence we have classified them separately for this analysis.
- NHS or Private: the type of public/private health service used for each appointment.
- Recurrence: if the sarcoma diagnosis was a recurrence or a primary diagnosis.
2.5. Assumptions and Logic
2.6. Missing Data
2.7. Clinical Confirmation of Sarcoma Subtype
2.8. Identifying Those with Misdiagnosis
2.9. Thematic Analysis
3. Results
3.1. Demographics
3.2. Patient Intervals
3.3. First Presentation to Biopsy and Diagnosis
3.4. Diagnostic Interval
3.5. Total Intervals (Symptom Onset to Diagnosis)
3.6. Symptoms and Diagnostic Pathway Characteristics
3.6.1. Bone Diagnosis Pathway Characteristics
3.6.2. Soft Tissue Diagnosis Pathway Characteristics
3.6.3. Head and Neck Diagnosis Pathway Characteristics
3.6.4. Gastrointestinal Tumour Diagnosis Pathway Characteristics
3.7. Misdiagnosis
“Initially, it was believed that I had cartilage damage in my knee, in the joint, because several years ago previous I’d been playing squash and experienced a lot of pain in that knee when I’d gone for a shot and lunged.” … “Was referred to physio, who just gave me, sort of, exercises to strengthen joints.”(Male, 25–39)
“I kept going to the doctors because I just didn’t feel any better, you know. When I first told them about the lump, all he did was tell me to go to the physio and just said it was just an infection.”(Male, 65+)
“I kept going to the doctors and he just kept giving me painkillers which weren’t really resolving the issue.” … “Had a [private] consultation to investigate the knee with an MRI on the knee and there was nothing wrong with it. My consultant said, ‘Oh well, just carry on. There’s nothing wrong with the knee.’” … “I think my GP let me down a bit…with the initial diagnosis and not listening properly and having to fight with him to get referrals. Literal verbal fighting to get referrals. That was probably the hardest bit.”(Male, 40–64)
“I went to see the GP in 1982, I can’t remember on how many occasions, but it might’ve been on two or three occasions, to try say something was wrong… He said, ‘It’s probably just strained it playing squash,’ and prescribed some painkillers, and suggested I don’t play squash for two weeks.”(Male, 65+)
“My GP, since 2013 until 2015, was explaining that the pain might be-, the main reason of the pain is tendinitis or worked too hard in the gym… So, I should just take some painkillers and some creams, anti-inflammatory creams, to relieve the pain, and that was it.” … “I felt definite, huge anger, because the main reason why this happened is because of the GP, who couldn’t treat me two years ago in a proper way. He didn’t listen to my concerns about my shoulder situation.”(Male, 25–39)
4. Discussion
4.1. Future Research
4.2. Strengths and Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Logic applied (considered as a general ‘rule of thumb’) |
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BS (n = 21) | STS (n = 41) | H and N (n = 9) | GIST (n = 7) | ||
---|---|---|---|---|---|
Gender | Male | 14 (67.7) | 18 (43.9) | 3 (33.3) | 5 (71.4) |
n (%) | Female | 7 (33.3) | 23 (56.1) | 6 (66.7) | 2 (28.6) |
Age in years | 13–24 | 3 (14.3) | 3 (7.3) | 1 (11.1) | 0 (0.0) |
n (%) | 25–39 | 10 (47.6) | 11 (26.8) | 2 (22.2) | 0 (0.0) |
40–64 | 5 (23.8) | 19 (46.3) | 5 (55.6) | 5 (71.4) | |
65+ | 3 (14.3) | 8 (19.5) | 1 (11.1) | 2 (28.6) |
Patient Interval (Days) | Diagnostic Interval (Days) | ||
---|---|---|---|
Median, Range | Median, Range | ||
Sarcoma | All | 13 (1–4971) | 87.5 (0–5474) |
Bone (n = 21) | 13 (1–372) | 127 (2–799) | |
STS (n = 41) | 14 (1–4971) | 86 (1–1276) | |
H and N (n = 9) | 14 (1–365) | 57 (8–2314) | |
GIST (n = 7) | 2 (1–60) | 13 (0–5474) | |
Male (n = 40) | All | 13 (1–4971) | 73 (0–5474) |
Bone (n = 14) | 13 (1–372) | 131 (10–799) | |
STS (n = 18) | 23.5 (1–4971) | 48 (3–900) | |
H and N (n = 3) | 26 (2–38) | 30 (8–88) | |
GIST (n = 5) | 2 (1–5) | 22 (0–5474) | |
Female (n = 38) | All | 13.0 (1–730) | 109.5 (1–2314) |
Bone (n = 7) | 14 (4–36) | 112 (2–223) | |
STS (n = 23) | 13 (1–730) | 120 (1–1276) | |
H and N (n = 6) | 10.5 (1–365) | 87.5 (15–2314) | |
GIST (n = 2) | 30.5 (1–60) | 7 (1–13) | |
13–24 years (n = 7) | All | 31 (4–762) | 57 (2–639) |
Bone (n = 3) | 31 (4–36) | 14 (2–128) | |
STS (n = 3) | 61 (14–762) | 229 (21–639) | |
H and N (n = 1) | 4 (4–4) | 57 (57–57) | |
GIST (n = 0) | n/a | n/a | |
25–39 years (n = 23) | All | 13 (1–372) | 120 (10–1276) |
Bone (n = 10) | 13 (1–372) | 123.5 (10–799) | |
STS (n = 11) | 13 (1–366) | 120 (26–1276) | |
H and N (n = 2) | 20 (14–26) | 108 (88–128) | |
GIST | n/a | n/a | |
40–64 years (n = 34) | All | 10 (1–1827) | 27 (0–5474) |
Bone (n = 5) | 13 (1–365) | 95 (61–239) | |
STS (n = 19) | 13 (1–1827) | 26 (1–900) | |
H and N (n = 5) | 38 (1–365) | 22 (8–2314) | |
GIST (n = 5) | 2 (1–5) | 2 (0–5474) | |
65+ years (n = 14) | All | 11 (1–4971) | 148.5 (3–1135) |
Bone (n = 3) | 11 (6–32) | 432 (146–662) | |
STS (n = 8) | 14 (1–4971) | 118.5 (3–1135) | |
H and N (n = 1) | 7 (7–7) | 118 (118–118) | |
GIST (n = 2) | 31 (2–60) | 568 (13–1123) |
Bone (n = 21) | STS (n = 41) | H and N (n = 9) | GIST (n = 7) | ||
---|---|---|---|---|---|
Main symptom(s) | Pain | 14 (66.7) | 7 (17.1) | 2 (22.2) | 2 (28.6) |
n (%) | Lump/swelling | 3 (14.3) | 25 (61.0) | 4 (44.4) | 2 (28.6) |
Other clinical examination 1 | 2 (9.5) | 0 (0.0) | 0 (0.0) | 0 (0.0) | |
Other 2 | 2 (9.5) | 8 (19.5) | 3 (33.3) | 3 (42.9) | |
Unknown | 0 (0.0) | 1 (2.4) | 0 (0.0) | 0 (0.0) | |
Recurrence | Yes | 3 (14.3) | 9 (22.0) | 1 (11.1) | 2 (28.6) |
n (%) | No | 18 (85.7) | 32 (78.0) | 8 (88.9) | 5 (71.4) |
Misdiagnosis | Yes | 7 (33.3) | 9 (22.0) | 3 (33.3) | 2 (28.6) |
n (%) | No | 14 (66.7) | 31 (75.6) | 6 (66.7) | 5 (71.4) |
Unsure | 0 (0.0) | 1 (2.4) | 0 (0.0) | 0 (0.0) | |
Time from symptom onset to diagnosis | Median days (min–max) | 136 (23–803) | 145 (4–5693) | 83 (16–2679) | 25 (1–5479) |
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Martin, S.; Clark, S.E.; Gerrand, C.; Gilchrist, K.; Lawal, M.; Maio, L.; Martins, A.; Storey, L.; Taylor, R.M.; Wells, M.; et al. Patients’ Experiences of a Sarcoma Diagnosis: A Process Mapping Exercise of Diagnostic Pathways. Cancers 2023, 15, 3946. https://doi.org/10.3390/cancers15153946
Martin S, Clark SE, Gerrand C, Gilchrist K, Lawal M, Maio L, Martins A, Storey L, Taylor RM, Wells M, et al. Patients’ Experiences of a Sarcoma Diagnosis: A Process Mapping Exercise of Diagnostic Pathways. Cancers. 2023; 15(15):3946. https://doi.org/10.3390/cancers15153946
Chicago/Turabian StyleMartin, Sam, Sigrún Eyrúnardóttir Clark, Craig Gerrand, Katie Gilchrist, Maria Lawal, Laura Maio, Ana Martins, Lesley Storey, Rachel M. Taylor, Mary Wells, and et al. 2023. "Patients’ Experiences of a Sarcoma Diagnosis: A Process Mapping Exercise of Diagnostic Pathways" Cancers 15, no. 15: 3946. https://doi.org/10.3390/cancers15153946