The use of clinical guidelines for referral of patients with lesions suspicious for oral cancer may ease early diagnosis and improve education of healthcare professionals

Resumo

Early diagnosis and referral of oral cancer is essential. Successful implementation of clinical guidelines must include current practitioners and students. Objective: To evaluate the diagnostic accuracy of students at oral cancer screening and to assess the effectiveness of clinical referral guidelines. Study Design: Fifth year dental students were randomly allocated to either control (n=19) or experimental groups (n=18). Both received the customary training in oral diagnosis. The experimental group underwent a 2 hour workshop where the guidelines for the referral of suspicious lesions were discussed. Three months later, a set of 51 clinical cases including benign, malignant, and precancerous conditions/lesions were used to assess the screening ability of each subject. Results: All 37 students entered the study. Sensitivity (control group) ranged from 16.7% to 66.7%; the experimental group scored from 16.7% to 83.3%. Fifty percent of the experimental students reached sensitivity values ≥62.5% (p=0.01). Diagnostic specificity (control group) spanned from 80% to 93.3% (median=50%); amongst experimental group it ranged from 82.2% to 97.8% (median=92.8%); (p=0.003). Concordance -control group- was X=82.5 (SD=3.2), and X=88.2 (SD=4.3) for the experimental, (p>0.001). Cohen's kappa test was poor (K<0.40) for the controls and moderate for the experimental group. The experimental group referred more oral cancers urgently (p=0.002) and left less unreferred cancers (0.04). This group also referred more precancerous lesions/conditions urgently (p=0.02). Conclusions: The implementation of a clinical referral guideline at undergraduate level has proved valuable, under experimental conditions, to significantly increase diagnostic abilities of the examiners and thus to improve screening for oral cancer. © Medicina Oral S. L.