ABSTRACT
The aim of this study was to identify key points and time intervals in the patient pathway to the diagnosis of oral cancer, from the detection of a bodily change to the start of treatment. A systematic search of three databases was performed by two researchers independently. Articles reporting original data on patients with symptomatic primary oral or oropharyngeal squamous cell carcinoma that was pathologically confirmed were included. These articles had to include an outcome variable of 'diagnostic delay', 'time interval', or 'waiting time to diagnosis', or report time intervals from first symptom to treatment. Furthermore, the outcome variable had to have a clearly defined start point and end point, with the time measurement presented as a continuous or categorical variable. A total of 1175 reports were identified; 28 articles on oral cancer studies and 13 on oral and oropharyngeal cancer studies were finally included. These papers showed poor quality in terms of questionnaire validation, acknowledgement of biases influencing time-point measurements, and strategies for verification of patient self-reported data. They also showed great heterogeneity. The review findings allowed the definition of key points and time intervals within the Aarhus framework that may better suit the features of the diagnostic process of this neoplasm, particularly when assessing the impact of waiting time to diagnosis.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Early Detection of Cancer , Mouth Neoplasms/diagnosis , Carcinoma, Squamous Cell/therapy , Delayed Diagnosis , Humans , Mouth Neoplasms/therapy , Time Factors , Time-to-TreatmentABSTRACT
La relación de los profesionales de salud con sus pacientes ha cambiado sustancialmente en este inicio del siglo XXI. El presente estudio tiene el objetivo de analizar los diferentes aspectos de la relación de los odontólogos con sus pacientes, en el contexto de la práctica odontológica. Inicialmente, el texto hace un análisis de la autonomía y el consentimiento, como principios bioéticos, en una incursión que va de la teoría, a la aplicación práctica concreta. En seguida, discute la utilización del consentimiento informado, sus ventajas, dificultades y su relación con la autonomía, en el contexto de las ciencias biomédicas y de la salud, especialmente en la odontología. Para finalizar, el trabajo defiende la premisa de que la relación odontólogo-paciente realmente adecuada, y jurídicamente correcta, es la construida bilateralmente, con respeto mutuo y toma compartida de decisiones.
The relationship between health professionals and their patients has substantially changed on the early 21st century. The purpose of the present study is to analyze the different approaches in the context of the dental practice. Initially the text analyzes autonomy and consent, as bioethical principles, from and approach theory to practice. Then, it discusses the use of informed consent, its advantages, difficulties, and its relationship with the autonomy, in the context of biomedical sciences and health -especially in odontology-. Finally, the work defends the premise that an adequate and legal relationship between patients and dentists should be a bilateral one, with mutual respect and shared decision making process.
