Delayed Diagnosis of Malignancy: Case Review for Advanced Practice Clinicians


In reviewing closed malpractice claims, The Doctors Company identified delayed diagnosis of a malignancy as a reoccurring problem. The following highlights the importance of recognizing a spinal abnormality and recommending further follow up of a lesion seen on imaging. Contributing factors include misinterpretation of radiologic studies, narrow diagnostic focus, lack of communication, and failure to establish a differential diagnosis.  

Course ID #: ANE 221128.0 Issue Date: 9/15/2022 Expiration Date: 9/15/2025

Description of the Professional Practice Gap (PPG)

In reviewing closed malpractice claims, The Doctors Company identified missed or delayed diagnoses in radiology claims as a recurring problem. This course highlights the importance of recognizing radiologic clinical judgement and communication lapses as contributing factors associated with a delayed diagnosis. Communications, thinking processes, and understanding limitations are highlighted in this case study.

Learning Outcome

Learners demonstrate application of knowledge and skills related to a patient at high risk for malignancy by answering the questions correctly that follow the Case Study.

Learning Objectives

After completing this activity, learners will be able to:

  • Recognize the challenges that often cause a delayed diagnosis of a spinal malignancy and results in a severe injury for a patient.
  • Identify ways to review, compare, and contrast less commonly seen characteristics of radiologic findings associated with spinal lesions.
  • Recognize the importance of accurate and thorough reporting of all radiologic findings including the possibility of a benign vs. malignant lesion and advise further testing to conform or rule this out.
  • Relate the importance of communicating and documenting incidental findings to the emergency physician or other providers.
  • Identify at least two strategies that can reduce the risk for a malpractice claim involving the failure to timely diagnose and treat a spinal malignancy.

Course Developers

Kimberly Hathaway, MSN, RN, CPHRM, CPHQ, Director Patient Safety Healthcare Quality & Risk Management, The Doctors Company
Kathrine Soulsby, BSN, RN, Senior Patient Safety Analyst, Department of Patient Safety and Risk Management, The Doctors Company
Johanna Lackner, MPH, MSW, Senior Director, Continuing Professional Development, Department of Patient Safety and Risk Management, The Doctors Company

Accreditation and Disclosure Statements
The Doctors Company is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

The Doctors Company designates this activity for a maximum of 0.5 nursing contact hourLearners should claim only the credit commensurate with the extent of their participation in the activity.
No individual in a position to control or influence the content of this activity has reported relevant financial relationships with commercial interests. No commercial support was provided for this activity. 

Disclaimer Statement
This program is being offered for informational and educational purposes only from a Patient Safety Risk Management perspective and does not constitute legal advice. Laws vary from state to state, actual clinical situations often involve subtle differences and nuances from program scenarios or recommendations, and the recommendations provided in this activity may not apply to all practice situations. In complex circumstances, which present significant potential for an adverse event or litigation, TDC and the faculty recommend you consult directly with your corporate or personal counsel for professional legal guidance. 

Complies with State Requirements

Please SEE the Registered Nurse and Licensed Practical Nurse CE Requirements by State.

Technical Requirements

The activity is best experienced using the most current browser: Firefox, Chrome, Safari, or Microsoft Edge. Internet Explorer is not supported on this platform. All activities featuring audio must have a speaker. To view graphic images and references that appear in separate "pop-up" windows, JavaScript and session cookies must be enabled on your computer. Adobe Acrobat Reader may be required for certain activities.

Contact Us

If you have questions, contact or call 800.421.2368.


Visit our Resource document for this program.