Referral pathways in colorectal cancer: general practitioners’ patterns of referral and factors that influence referral

Project Coordinator

Shane Pascoe

Chief Investigators

Mark Harris

Associate Investigators

Shane Pascoe

Rationale

There is some evidence in Australia that not all patients receive the best care for colorectal cancer. Key areas for improvement include the timely detection of CRC and the referral of patients to surgeons and to services which are experienced and provide adjuvant therapy and multi-disciplinary care. These require improvements to the network of services as well as the referral pathway which begins with GPs. In the UK, only a minority of patients are referred according to the optimal pathway. In Australia however, there is very little information on this critical element. This project will examine current patterns of referral of patients diagnosed with CRC to specialist services. This will include a study of factors influencing GPs’ patterns of referral and a study of consumers’ views about the patient journey and their experiences of the referral pathway from GPs to cancer specialist care.

Aims

The project aims to increase our understanding of the pattern and factors influencing the referral of colorectal cancer (CRC) patients when first diagnosed from general practices to specialists in cancer care. CRC is used as a model for cancer treatment referral because of the variations in practice and outcomes. The specific objectives are: To describe how people first diagnosed with CRC are referred for specialist treatment including: who refers them, the time from colonoscopy to attendance at referral, and the treatment services offered on referral. To examine the predictors of treatment in a cancer centre of expertise including demographic and illness characteristics of the CRC patient. To describe the distribution of the volume of CRC patients seen by surgeons and by whom they were referred. To examine the views of general practitioners (GPs) about referral for CRC, the factors that they believe influence referral to a centre of expertise, and barriers and facilitators to such referral. To examine the views of CRC patients about referral for CRC, including treatment at a centre of expertise. To identify key strategies for improving the referral pathway from general practice to cancer specialist referral services.

Design and Method

We propose a four phase project focused on patients with a definitive diagnosis of a primary CRC. The cancer could have been detected: following screening; as an incidental finding in the course of routine physical examination; in the course of regular investigations, including periodic colonoscopy for individuals at high risk, such as those with ulcerative colitis or familial polyposis; or following presentation with symptoms such as rectal bleeding, altered bowel habit or abdominal pain. Study 1- Patterns of referral in NSW. Study 2 - Reasons for referral. Study 3 - Factors influencing GPs’ referral. Study 4 - Patients’ perceived influence and expectations of the referral process.