{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T23:37:27Z","timestamp":1772149047974,"version":"3.50.1"},"reference-count":33,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,1,30]],"date-time":"2025-01-30T00:00:00Z","timestamp":1738195200000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2024,12,6]]},"published-print":{"date-parts":[[2025,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To characterise diagnostic pathways for patients with melanoma in routine practice and compare patient, disease and diagnostic interval (DI) characteristics across pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Descriptive cross-sectional study using administrative health data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Population-based study in Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Patients with melanoma diagnosed from 2007 to 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>\n                      We used latent class cluster analysis to create clusters of patients with similar diagnostic experiences to characterise diagnostic pathways in routine practice. Indicator variables characterised the patient\u2019s keratinocyte carcinoma and dermatologist history, presentation pattern, procedure types, number of visits and procedures, and the activity on the diagnosis date. \u03c7\n                      <jats:sup>2<\/jats:sup>\n                      tests and Pearson residuals were used. We characterised clusters by the lengths of their DI, primary care subinterval and specialist care subinterval.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>There were 33\u2009371 patients diagnosed with melanoma from 2007 to 2019. We identified four diagnostic pathways: \u2018primary care only\u2019 (n=6107), \u2018referred to specialist with immediate action\u2019 (n=8987), \u2018multiple visits and procedures in specialist care\u2019 (n=11\u2009893) and \u2018specialist care only\u2019 (n=6384). Patient, disease and DI characteristics varied across pathways. Pathway types varied regionally. A higher proportion in the \u2018primary care only\u2019 pathway lived in rural areas whereas a higher proportion in the \u2018referred to specialist for immediate action\u2019 and the \u2018specialist care only\u2019 pathways lived in major urban centres. Across pathways, the median DI varied from 1 to 67\u2009days, the median primary care subinterval varied from 1 to 30\u2009days and the median specialist care subinterval varied from 1 to 25\u2009days. Patients in the \u2018primary care only\u2019 pathway experienced the shortest DIs, and patients in the \u2018multiple visits and procedures in specialist care\u2019 pathway experienced the longest DIs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and relevance<\/jats:title>\n                    <jats:p>We identified four melanoma diagnostic pathways. The shortest DI, the \u2018primary care only\u2019 pathway, highlights the important role of primary care and the need to reduce the wait for specialists. Diagnostic processes varied across geographical locations. Future research should address reasons for these differences, including whether they are associated with inefficient or inappropriate care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2024-086140","type":"journal-article","created":{"date-parts":[[2025,1,31]],"date-time":"2025-01-31T01:25:34Z","timestamp":1738286734000},"page":"e086140","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Characterising melanoma diagnostic pathways for patients in routine practice using administrative health data in Ontario, Canada: a population-based study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6876-4822","authenticated-orcid":false,"given":"Meaghan E","family":"Mavor","sequence":"first","affiliation":[{"name":"Division of Cancer Care and Epidemiology, Sinclair Cancer Research Institute, Queen's University, Kingston, Ontario, Canada"},{"name":"Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patti A","family":"Groome","sequence":"additional","affiliation":[{"name":"Division of Cancer Care and Epidemiology, Sinclair Cancer Research Institute, Queen's University, Kingston, Ontario, Canada"},{"name":"Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuka","family":"Asai","sequence":"additional","affiliation":[{"name":"Division of Dermatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugh","family":"Langley","sequence":"additional","affiliation":[{"name":"Department of Oncology, Queen's University, Kingston, Ontario, Canada"},{"name":"South East Regional Cancer Program, Kingston, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicole J","family":"Look Hong","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frances C","family":"Wright","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada"},{"name":"Department of Surgery, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timothy P","family":"Hanna","sequence":"additional","affiliation":[{"name":"Division of Cancer Care and Epidemiology, Sinclair Cancer Research Institute, Queen's University, Kingston, Ontario, Canada"},{"name":"Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada"},{"name":"Department of Oncology, Queen's University, Kingston, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2025,1,30]]},"reference":[{"key":"2025121400424479000_15.1.e086140.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2010.05439.x"},{"key":"2025121400424479000_15.1.e086140.2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.1929"},{"key":"2025121400424479000_15.1.e086140.3","doi-asserted-by":"publisher","DOI":"10.1097\/01.NCC.0000305744.64452.fe"},{"key":"2025121400424479000_15.1.e086140.4","doi-asserted-by":"crossref","unstructured":"Guan Z , Webber C , Flemming JA , et al . 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