Learning and Recommendations from Significant Event Analyses of Bowel Cancer Cases
Bowel cancer is the second leading cause of cancer-related mortality in the UK. Early diagnosis provides opportunities for intervention and improved survival. Significant Event Analysis (SEA) is a well-established quality improvement approach for learning from new cancer diagnoses. This project aimed to improve understanding of the diagnostic pathway for bowel cancer and to identify areas for improvement in patient care from a primary care perspective.
General Practices across Pennine Lancashire were invited to undertake SEAs of one or more bowel cancer cases from the preceding three years as part of an incentivised scheme. Anonymised data were collected on a standardised form. Practices provided learning outcomes and recommendations for the practice, hospital and local Clinical Commissioning Groups (CCGs). 53/75 (71%) practices submitted 161 reports for descriptive and thematic analysis.
86 (53%) patients were male and the mean age at diagnosis was 68 years (SD 14). There was a central theme of “building vigilance and collaboration” between and within general practices and secondary care. “Building vigilance” pertains to recognition of complex and atypical presentations of bowel cancer, while accounting for diagnostic overshadowing and having a reduced threshold for 2-week suspected cancer referrals. “Building collaboration” emphasises timely follow-up, ownership of care, and clear communication between primary and secondary care. Access to screening and investigations are paramount for improving early diagnosis, however, a flexible diagnostic approach is required according to the individual circumstances of each patient.
Why it matters
These findings confirm and provide additional insights to the existing literature on bowel cancer from a primary care perspective. Practices should be supported in developing protocols for assessment and follow-up of patients with varying presentations. The range of cases from multi-site SEA should be utilised across Primary Care Networks for peer-peer learning and identification of Network-wide improvements in cancer pathways.
Presenting Author: Achint Bajpai1 (firstname.lastname@example.org, Twitter: @achint_25)
Nicola Cooper-Moss1 (email@example.com)
Neil Smith2 (firstname.lastname@example.org)
Angela Dunne2 (email@example.com)
Umesh Chauhan1 (UChauhan@uclan.ac.uk)
1. School of Medicine, Faculty of Health and Biomedical Sciences, University of Central Lancashire, Preston, UK.
2. Lancashire and South Cumbria Cancer Alliance, UK.