Referral pathways in colorectal cancer: an audit of surgeons’ records
Allan D. Spigelman A F , Shane W. Pascoe B , Mark F. Harris B , Justin J. Beilby C , Lisa J. Crossland D , Rohan M. Gett A , Michael B. Barton E and Upali W. Jayasinghe BA University of New South Wales, St Vincent’ s Clinical School, Cancer Services, St Vincents and Mater Health Sydney, Sydney, NSW 2010, Australia.
B University of New South Wales Research Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW 2031, Australia.
C Discipline of General Practice, University of Adelaide, Adelaide, SA, Australia.
D Mount Isa Centre for Rural and Remote Health, James Cook University, Department of Rural Health, Mt Isa, Qld 4825, Australia.
E Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Health Service, Liverpool, NSW 2170, Australia.
F Corresponding author. Email: aspigelman@stvincents.com.au
Australian Health Review 37(4) 449-452 https://doi.org/10.1071/AH13038
Submitted: 13 February 2013 Accepted: 27 May 2013 Published: 15 July 2013
Abstract
Purpose. To explore the referral pathways of patients with newly diagnosed colorectal cancer to surgeons.
Method. Australian surgeons from three states completed a questionnaire and their records were audited.
Results. Thirty-three surgeons provided data on 530 patients seen in the preceding 12 months. The median time between colonoscopy and first surgical consult was 10 days, with 19% of patients waiting more than 28 days. After adjustment for clustering, no surgeon factors were associated with the number of days between colonoscopy and surgery. A report back to the general practitioner (GP) was found in 78% of patients’ records. This feedback varied between surgeons but none of the specific surgeon characteristics examined could explain this.
Conclusion. Surgeons usually communicated with GP regardless of whether they were the referral source. However, communication with GP varied considerably among surgeons, with no evidence of a report to the GP in one-fifth of cases.
What is known about the topic? Referral from general practice is the main pathway to specialist services in Australia. There has been little research describing factors that affect referral patterns, particularly following diagnosis of cancer to investigation for surgery.
What does this paper add? A significant minority of GP were not informed of the referral for colonoscopy and did not receive a copy of the report. No surgeon factors were associated with the number of days between colonoscopy and surgery.
What are the implications for practitioners? Although the referral pathway for colorectal cancer often begins in general practice, GP are not always fully informed of the pathways used and other important treatment decisions. Improved use of audit, dissemination of results and improved information exchange generally may all make a significant impact.
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