Rapid diagnostic pathways for suspected colorectal cancer: views of primary and secondary care clinicians on challenges and their potential solutions.
OBJECTIVE
To ascertain the challenges associated with implementation of the 2-week wait referral criteria and waiting time targets for colorectal cancer and to identify recommendations for improvements to the pathway.


METHODS
Qualitative research using semistructured interviews and applying thematic analysis using the method of constant comparison.


METHODS
10 primary care surgeries and 6 secondary care centres from 3 geographical areas in the England.


METHODS
Purposive sample of 24 clinicians (10 general practitioners (GPs), 7 oncologists and 7 colorectal surgeons).


RESULTS
GPs and specialists highlighted delays in patient help-seeking, difficulties applying the colorectal cancer referral criteria due to their low predictive value, and concerns about the stringent application of targets because of potential impact on individual care and associated penalties for breaching. Promoting patient awareness and early presentation, clarifying predictive symptoms, allowing flexibility, optimising resources and maximising care coordination were suggested as improvements.


CONCLUSIONS
Challenges during diagnosis and treatment persist, with guidelines and waiting time targets producing the perception of unintended harms at individual and organisational levels. This has led to variations in how guidelines are implemented. These require urgent evaluation, so that effective practices can be adopted more widely.
NIHR CLAHRC West, University of Bristol, Bristol, UK School of Social and Community Medicine, University of Bristol, Bristol, UK.
Maria Theresa
MT
Redaniel
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Matthew
M
Ridd
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Richard M
RM
Martin
Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital, Newcastle upon Tyne, UK.
Fareeda
F
Coxon
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Mona
M
Jeffreys
School of Social and Community Medicine, University of Bristol, Bristol, UK.
Julia
J
Wade
D015179:Colorectal Neoplasms / Q000175:diagnosis*; D019091:Critical Pathways; D004739:England; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D010342:Patient Acceptance of Health Care; D010465:Perception; D011320:Primary Health Care / Q000592:standards; D036301:Qualitative Research; D012017:Referral and Consultation; D063127:Secondary Health Care / Q000592:standards; D013038:Specialization