Guideline discordant diagnostic care: when do referrals not reflect guidelines for suspected cancer?

Who is involved?

Summary

Patients diagnosed with cancer in Britain have poorer survival than those from many similar countries around the world. This is partly attributed to the fact that in the UK patients tend to be diagnosed with more advanced cancer than elsewhere. As part of a strategy to combat this, new guidelines for GPs were introduced in 2015 advising on which patients should be referred to hospital for investigation using a fast-track system known as the “two-week wait”.

In this study we will look at how often GPs follow the guidelines and whether certain types of patients (e.g. men or women, old or young) or patients with certain symptoms are more or less likely to be urgently referred when the guidelines suggest they should be. We will then look at whether any of these differences are explainable, for example due to the presence of urinary infections in women which may have the same symptom as bladder cancer.

Finally we will look at differences in following guidelines between different doctors and in different practices. If we can identify what types of patients are not being referred according to guidelines we can improve education materials for doctors. If we find large variation by doctors in whether guidelines are followed it may be possible to target improvement efforts at certain doctors.

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