Perspectives of San Juan healthcare practitioners on the detection deficit in oral premalignant and early cancers in Puerto Rico: a qualitative research study

Abstract

BackgroundIn Puerto Rico, relative to the United States, a disparity exists in detecting oral precancers and early cancers. To identify factors leading to the deficit in early detection, we obtained the perspectives of San Juan healthcare practitioners whose practice could be involved in the detection of such oral lesions.MethodsKey informant (KI) interviews were conducted with ten clinicians practicing in or around San Juan, Puerto Rico. We then triangulated our KI interview findings with other data sources, including recent literature on oral cancer detection from various geographic areas, current curricula at the University of Puerto Rico Schools of Medicine and Dental Medicine, as well as local health insurance regulations.ResultsKey informant-identified factors that likely contribute to the detection deficit include: many practitioners are deficient in knowledge regarding oral cancer and precancer; oral cancer screening examinations are limited regarding which patients receive them and the elements included. In Puerto Rico, specialists generally perform oral biopsies, and patient referral can be delayed by various factors, including government-subsidized health insurance, often referred to as Reforma. Reforma-based issues include often inadequate clinician knowledge regarding Reforma requirements/provisions, diagnostic delays related to Reforma bureaucracy, and among primary physicians, a perceived financial disincentive in referring Reforma patients.ConclusionsAddressing these issues may be useful in reducing the deficit in detecting oral precancers and early oral cancer in Puerto Rico.

Patient perspectives of diagnostic delay for suspicious oral mucosal lesions

“…These results do not support the hypothesis that patients may delay affecting a referral if they do not believe that their condition is serious. 35,36 This study was unable to identify a particular trait which could delay patient attendance to a specialist. This again emphasizes the importance of patient follow-up, as there may not be a particular referral communication strategy that will promote prompt use of a specialist referral.…”

Conocimientos sobre factores de riesgo asociados a cáncer bucal en adultos residentes en el municipio de San Salvador

“…6 A partir de ello, se deduce que la ausencia de un examen clínico bucal provoca retrasos en el diagnóstico de la enfermedad. Por tal motivo, la identificación y la detección temprana del cáncer bucal no sólo garantizan un incremento en la tasa de supervivencia sino también una mejora en la calidad de vida como resultado de tratamientos médicos menos agresivos.…”

Oral Cancer and Potentially Cancerous Lesions - Early Detection and Diagnosis

“…55 Practitioners agreed that patients of low socioeconomic background exhibited greater delay. 58 This is exemplified by the high patient delay experienced in the USA compared to Canada. 10 The USA has a healthcare system whereby individuals pay for their own health expenses, whereas in Canada some healthcare is provided by the government.…”

“…35 Courses have been shown to be effective in promoting screening methods, with practitioners reporting better screening habits following attendance. 35,58 A lack of confidence in detection has been made apparent as some dentists did not feel that they should deal with diseases such as cancer as they are "not medical doctors". 35 This lack of confidence also extends to doctors, as both doctors and dentists felt that they had inadequate training and were not confident in detecting oral lesions.…”

“…35,58 Participants in one study wanted to know more about referral pathways, biopsy procedure and guidelines for screening. 35 Courses have been shown to be effective in promoting screening methods, with practitioners reporting better screening habits following attendance.…”