Alexander Ross Kerr1, Michael E Robinson2, Cyril Meyerowitz3, Douglas E Morse3, Maria L Aguilar4, Scott L Tomar5, Lisa Guerrero6, Dianne Caprio7, Linda M Kaste8, Sonia K Makhija9, Rahma Mungia10, Linda Rasubala11, Walter J Psoter3. 1. Department of Oral and Maxillofacial Pathology, Radiology, and Medicine, New York University College of Dentistry, New York, NY, USA. Electronic address: ark3@nyu.edu. 2. Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA. 3. Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA. 4. Department of Restorative Dental Science, Division of Prosthodontics, University of Florida College of Dentistry, Gainesville, FL, USA. 5. Department of Community Dentistry and Behavioral Science, University of Florida College of Dentistry, Gainesville, FL, USA. 6. Permanente Dental Associates, Portland, OR, USA. 7. Faculty Director of General Dentistry, Brunswick County-CSLC, Department of General Dentistry, School of Dental Medicine, East Carolina University, Greenville, NC, USA. 8. Department of Pediatric Dentistry, University of Illinois College of Dentistry, Chicago, IL, USA. 9. Department of Clinical and Community Sciences, Division of Behavioral and Population Sciences, University of Alabama at Birmingham, Birmingham, AL, USA. 10. Associate Professor, Department of Periodontics; Director, South Texas Oral Health Network; Assistant Director, Southwest Region National Dental PBRN, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA. 11. Assistant Director Howitt Urgent Dental Care, Eastman Institute for Oral Health, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.
Abstract
OBJECTIVE: The aim of this study was to assess the influence of clinical cues on risk assessment of cancer-associated mucosal abnormalities. STUDY DESIGN: We differentiated lesions with a low risk from those with a high risk for premalignancy or malignancy by using 4 cues: (1) color, (2) location, (3) induration, and (4) pain on exploration. Combinations of color and location were presented through 8 photographs, with induration and pain status variably presented in the standardized history and physical findings. This created 16 clinical scenarios (vignettes) that were permutations of the 4 cues. Three questions assessed the extent to which each cue was used in obtaining a clinical impression as to whether a lesion was benign, premalignant, or malignant. RESULTS: Completed vignette questionnaires were obtained from 130 of 228 invited dentists, (two-thirds males; 79% white; mean age 52 years; average weekly hours of practice 33 hours). Only 40% of the responding dentists had statistically significant decision policies to assign a clinical diagnosis of a lesion as benign, premalignant, or malignant. Lesion location and color were the 2 dominant cues. As a cue, induration was used as a cue by more of the respondents in determining a clinical diagnosis of malignancy, and pain was infrequently used as a cue. CONCLUSIONS: Many dentists do not to have a decision strategy for the clinical diagnosis and risk stratification of oral potentially malignant lesions.
OBJECTIVE: The aim of this study was to assess the influence of clinical cues on risk assessment of cancer-associated mucosal abnormalities. STUDY DESIGN: We differentiated lesions with a low risk from those with a high risk for premalignancy or malignancy by using 4 cues: (1) color, (2) location, (3) induration, and (4) pain on exploration. Combinations of color and location were presented through 8 photographs, with induration and pain status variably presented in the standardized history and physical findings. This created 16 clinical scenarios (vignettes) that were permutations of the 4 cues. Three questions assessed the extent to which each cue was used in obtaining a clinical impression as to whether a lesion was benign, premalignant, or malignant. RESULTS: Completed vignette questionnaires were obtained from 130 of 228 invited dentists, (two-thirds males; 79% white; mean age 52 years; average weekly hours of practice 33 hours). Only 40% of the responding dentists had statistically significant decision policies to assign a clinical diagnosis of a lesion as benign, premalignant, or malignant. Lesion location and color were the 2 dominant cues. As a cue, induration was used as a cue by more of the respondents in determining a clinical diagnosis of malignancy, and pain was infrequently used as a cue. CONCLUSIONS: Many dentists do not to have a decision strategy for the clinical diagnosis and risk stratification of oral potentially malignant lesions.
Authors: Walter J Psoter; Douglas E Morse; Melba Sánchez-Ayendez; Carmen M Vélez Vega; Maria L Aguilar; Carmen J Buxó-Martinez; Jodi A Psoter; Alexander R Kerr; Christina M Lane; Vincent J Scaringi; Augusto Elias Journal: J Cancer Educ Date: 2015-06 Impact factor: 2.037