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A systematic rapid evidence assessment of late diagnosis

Caird, Jenny and Hinds, Kate and Kwan, Irene and Thomas, James (2012) A systematic rapid evidence assessment of late diagnosis. [Report]

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Abstract

Delayed diagnosis results in serious consequences for patients and healthcare professionals and can incur substantial financial costs. Whilst research focusing upon cancer suggests that late diagnosis leads to increased morbidity and mortality, the evidence for other conditions is less clear. This systematic rapid evidence assessment (SREA) identifies and characterises late diagnosis across a range of conditions. We examined evidence from systematic reviews for: chronic kidney disease, dementia, depression, type I diabetes, epilepsy, HIV, myocardial infarction, psychosis, stroke and tuberculosis. We also looked at evidence from UK primary studies for chronic obstructive pulmonary disease (COPD), tuberculosis and epilepsy. While there were relevant systematic reviews to draw on for most conditions, this was not the case for COPD, tuberculosis and epilepsy. We identified 43 systematic reviews investigating late diagnosis. UK primary studies investigating late diagnosis numbered 606, of which 12 investigated COPD, 12 investigated tuberculosis and 4 investigated epilepsy. Findings: Late diagnosis is of most concern for those with COPD, Dementia, HIV and Type 1 Diabetes. COPD has a high prevalence of late diagnosis, with an estimated 80% of cases remaining undiagnosed. Many of these cases are patients in the milder stages of the disease. Early dementia is harder to detect, with doctors acknowledging their difficulties in distinguishing between dementia and ‘normal ageing’. The evidence suggested that a substantial proportion (16–51%) of children experience delayed diagnosis in type I diabetes. Those engaging in high-risk behaviours were more likely to avoid HIV testing due to fear of a positive diagnosis, with worrying implications regarding onward transmission. Data from the Health Protection Agency indicates that 50% of new diagnoses are late in the UK. Broadly, late diagnosis affects vulnerable groups such as older people or those living in poverty. Patients delayed seeking help from clinicians for a number of conditions including chronic kidney disease, dementia, HIV, stroke, myocardial infarction, epilepsy and tuberculosis. Late presentation was linked to symptom misinterpretation and lack of knowledge. Inadequate knowledge and training of doctors were barriers to prompt diagnosis for chronic kidney disease, COPD, dementia and tuberculosis. Restricted access, insufficient consultation time and resource constraints hindered diagnosis. There was very little material about the cost implications of delayed diagnosis. Implications: The training of doctors in the early diagnosis of COPD, dementia and tuberculosis has improved detection. Media campaigns to alert the public to the symptoms of stroke, heart attack and psychosis have had mixed results. Overall, public recognition has increased, but this may not have contributed to shortening patient delay.

Item Type: Report
Controlled Keywords: Diagnosis, Health and wellbeing
Divisions: IOE Departments > Departments > Social Science Research Unit
Depositing User: Atira Pure
Date Deposited: 01 Jun 2013 04:22
Last Modified: 29 Jan 2015 10:26
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