Oral cancer care readiness in secondary dental services: associations with service structure and work process

Oral cancer is a prevalent condition with a high mortality rate, especially in low- and middle-income countries. In Brazil, Dental Specialty Centers (Portuguese acronym: Centros de Especialidades Odontológicas - CEOs) are responsible for secondary care and play an essential role in the early detection of oral cancer; therefore, it is strategic to analyze the structure and work process of these centers. To analyze whether general elements of the structure and work process in dental offices are associated with the adequacy of oral cancer care readiness (OCCR). Cross-sectional study based on secondary data from the second cycle of the National Program for Improving Access and Quality of Dental Specialty Centers (PMAQ-CEO), including 1.042 CEOs. The outcome of the study was the adequacy of OCCR in the CEOs, categorized as “adequate” when the office had at least one Oral Medicine professional, performed biopsies, registered users with suspected or diagnosed cases, had referral for histopathological exam, had referral clinical protocol and referred confirmed cases for treatment; otherwise, the outcome was classified as “inadequate”. Structural Equation Modeling (SEM) was used, which allows the observation of direct and indirect associations between structure, process, and outcome variables, estimating standardized coefficients (SC) (α = 5%). The measurement model for the latent variables was evaluated using Confirmatory Factor Analysis (CFA). Only 41.65% of CEOs provided adequate OCCR. Larger CEO type (SC = 0.333; p = 0.014), better organizational structure represented by monitoring and self-evaluation (SC = 0.419; p < 0.001), and greater availability of instruments in usable condition (SC = 0.806; p < 0.001) showed direct positive associations with OCCR. CEO type also exerted an indirect positive effect through the pathway involving dental chairs and instruments (SC = 0.156; p = 0.028), whereas an inverse indirect association through instrument availability was observed (SC = − 0.190; p = 0.038). Monitoring and self-evaluation also had a positive indirect effect mediated by instrument availability (SC = 0.330; p < 0.001). The final SEM presented adequate fit indices. Less than half of the CEOs presented adequate OCCR. Although larger CEOs tend to have better conditions, organizational practices and the availability of instruments were more strongly associated with adequate OCCR than physical expansion alone, suggesting that investments in infrastructure should be accompanied by effective management and organization of care to improve oral cancer services.