The objective of this award is to provide the applicant with the experience, mentoring and knowledge necessary to become an independent health services researcher in the field of diagnostic errors in cancer. Diagnostic errors are likely the most common type of error in primary care and are the most expensive. Missed and delayed cancer diagnoses are particularly frequent, harmful and costly. Errors in cancer diagnosis are poorly understood and difficult to study. Although diagnostic errors have been shown to have both systems and cognitive origins, there is no comprehensive theory of medical diagnostic problem-solving that addresses both types of factors. However, the situational awareness framework used in aviation safety research encompasses cognitive and system origins of pilots'decision-making errors and may offer solutions to improving the diagnostic process as well. Situational awareness precedes and is critical to effective decision-making, a key element in conceptualization of a correct diagnosis. The research goal is to use the situational awareness framework, which has the potential to address both systems and cognitive origins of medical decision-making errors, to identify key determinants of missed and delayed breast, lung and colon cancer diagnoses. The overall hypothesis is that the situational awareness framework can be used to identify the major cognitive and systems vulnerabilities in the diagnostic process and to suggest future targets for improvement. In preliminary work, the applicant has used this framework to study the process of diagnostic decision-making in cancer. Taking advantage of interdisciplinary resources from several institutions in the Texas Medical Center, collaborative expertise from the National Aeronautics and Space Administration, and clinical scenarios available through a National Cancer Institute-funded consortium, the specific aims are:
Aim 1 : To use the situational awareness framework to retrospectively identify the major system factors that lead to diagnostic errors in cancer.
Aim 2 : To use the situational awareness framework in a simulated setting to prospectively identify the major cognitive errors in cancer-related diagnostic decision-making.
Aim 3; To study prospectively the effects of cognitive and system factors and their interplay on situational awareness in diagnosis of cancers in real clinical settings. The applicant has extensive clinical experience and is currently obtaining basic research skills through an NIH-funded K30 program. To achieve his goal of understanding and reducing diagnostic errors he needs advanced research skills and mentored training in specific content disciplines. A highly qualified interdisciplinary advisory team will supervise training that will include mentored research, formal coursework, directed readings and seminars. The proposed activities will provide a multidisciplinary foundation to reduce diagnostic errors in cancer and will provide the applicant with the experiences and skills he needs to achieve independence in a health outcomes research career focused on cancer diagnoses.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Mentored Patient-Oriented Research Career Development Award (K23)
Project #
5K23CA125585-03
Application #
7659569
Study Section
Subcommittee G - Education (NCI)
Program Officer
Lim, Susan E
Project Start
2007-08-01
Project End
2012-07-31
Budget Start
2009-08-01
Budget End
2010-07-31
Support Year
3
Fiscal Year
2009
Total Cost
$141,750
Indirect Cost
Name
Baylor College of Medicine
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
051113330
City
Houston
State
TX
Country
United States
Zip Code
77030
Kwan, Janice L; Singh, Hardeep (2017) Assigning responsibility to close the loop on radiology test results. Diagnosis (Berl) 4:173-177
Singh, Hardeep; Graber, Mark L; Hofer, Timothy P (2016) Measures to Improve Diagnostic Safety in Clinical Practice. J Patient Saf :
Giardina, Traber Davis; Sarkar, Urmimala; Gourley, Gato et al. (2016) Online public reactions to frequency of diagnostic errors in US outpatient care. Diagnosis (Berl) 3:17-22
Singh, Hardeep; Arora, Neeraj K; Mazor, Kathleen M et al. (2015) A vision for using online portals for surveillance of patient-centered communication in cancer care. Patient Exp J 2:125-131
Zwaan, Laura; Singh, Hardeep (2015) The challenges in defining and measuring diagnostic error. Diagnosis (Berl) 2:97-103
Giardina, Traber Davis; Modi, Varsha; Parrish, Danielle E et al. (2015) The patient portal and abnormal test results: An exploratory study of patient experiences. Patient Exp J 2:148-154
Bhise, Viraj; Singh, Hardeep (2015) Measuring diagnostic safety of inpatients: time to set sail in uncharted waters. Diagnosis (Berl) 2:1-2
Murphy, Daniel R; Laxmisan, Archana; Reis, Brian A et al. (2014) Electronic health record-based triggers to detect potential delays in cancer diagnosis. BMJ Qual Saf 23:8-16
Singh, Hardeep; Meyer, Ashley N D; Thomas, Eric J (2014) The frequency of diagnostic errors in outpatient care: estimations from three large observational studies involving US adult populations. BMJ Qual Saf 23:727-31
Berlin, Leonard; Murphy, Daniel R; Singh, Hardeep (2014) Breakdowns in communication of radiological findings: an ethical and medico-legal conundrum. Diagnosis (Berl) 1:263-268

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