Patient Recall of Oral Cancer Screening Examinations

Objectives: To examine patient recall of oral cancer screening examinations (OCS) compared to chart review during an admitting visit to a dental school clinic.

Methods: Seventy-four adult patients were interviewed by one investigator who administered 12 questions and recorded responses on a standardized form.  Patients reported recall of OCS, radiographs (RAD), blood pressure(BP), and tobacco use(TOB); responses were compared to charted data for percent agreement. Because the proportion of negative agreement was zero for most procedures, a prevalence adjusted bias adjusted kappa (PABAK) was calculated.  Open-ended questions were qualitatively summarized.

Results:   On average, patients were 51 years old (±17, range 19-85) and were interviewed 4.2 days (±2, range 1-8) after the admitting visit; 50% of patients were male.   Percent agreement was highest for recall of BP (98.6%), RAD (98.6%), and TOB (92%), but lower for recall of OCS(84%).  The adjusted kappas (BP, .97; RAD, .97; TOB, .84; OCS, .68) reflected the high negative agreement for the procedures as well the possible failure to chart OCS which patients reported (n=8). Patient recall was not associated with age, sex or time since admit visit.  49% of patients reported the provider using the phrase ‘oral cancer’ while 23% did not remember; only 32% reported being informed of the results of the OCS, e.g. ‘I don’t see anything out of the ordinary’, while 16% did not remember.   Among 19 patients who were smokers, only 6 recalled information about risk factors for oral cancer.

Conclusions: Compared to other procedures during the admit visit, the concordance between patient recall and charting for OCS is lower.  OCS performance and findings may not be as routinely charted as needed.  Missed opportunities to discuss oral cancer risks among dental patients, especially among smokers, were identified.  Better communication to inform patients of the OCS and findings is warranted.