Two week rule compliance: assessing general practice use of the 'Two Week Rule' referral pathway for the suspicion of colorectal cancer

Khan, K. S. , Grayston, A., Denley, S., Saldanha, J. and Mukherjee, A. (2021) Two week rule compliance: assessing general practice use of the 'Two Week Rule' referral pathway for the suspicion of colorectal cancer. Annals of Public Health Reports, 5(1), pp. 172-178. (doi: 10.36959/856/516)

Abstract

Background: The 'Two-Week-Rule' (TWR) for referring patients with a suspicion of colorectal cancer (CRC) was implemented in 2000 to improve CRC survival rates. Guidelines exist to assist general practitioners (GPs) identify patients based on high-risk symptomology. Our aim was to evaluate the effectiveness of these guidelines, to determine whether a correlation exists between individual criteria within the guidelines and CRC, and to assess GP compliance of guidelines in referring symptomatic patients. Methods: 485 consecutive 'TWR' referrals to colorectal unit in a district general hospital and all patients diagnosed with CRC or high grade dysplasia (HGD) regardless of referral route, were prospectively collected between July and December 2015. Both lists were independently maintained and retrospectively analysed. Results were cross-examined for accuracy and main measures include: reason(s) for referral, secondary-care investigation(s) and diagnoses. Results: GPs referred 333 patients based on symptomology suggestive of CRC; while referring an additional 152 patients (31.3%) that failed to meet NICE guidelines for TWR referral. CRC or HGD was diagnosed in 28 patients; 27 of whom (96.4%, p = 0.0005) were identified through a guideline compliant referral. During the study period 79 cases of CRC or HGD were diagnosed from all referral routes; 36.7% through the 'TWR' referral pathway. Conclusion: Updated NICE referral guidelines for suspected CRC appear to be effective in identifying patients with CRC based on high-risk symptomology. Guideline compliance from GPs remains a barrier in the 'TWR' referral system. GPs paradoxically over-refer guideline non-complaint patients, while under-referring guideline complaint patients; reducing the effectiveness of the 'TWR' referral system.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Khan, Mr Khurram
• Authors: Khan, K. S., Grayston, A., Denley, S., Saldanha, J., and Mukherjee, A.
• College/School: College of Medical Veterinary and Life Sciences > School of Cancer Sciences; College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
• Journal Name: Annals of Public Health Reports
• Publisher: Scholars.Direct
• ISSN: 2642-4924
• ISSN (Online): 2642-4924
• Published Online: 15 February 2021
• Copyright Holders: Copyright © 2021 Khan KS, et al.
• First Published: First published in Annals of Public Health Reports 5(1):172-178
• Publisher Policy: Reproduced under a Creative Commons license