Shane W Pascoe

Identifying patients with a cancer diagnosis using general practice medical records and Cancer Registry data.

BACKGROUND The medical records of patients with cancer need to accurately record diagnoses for professionals to provide quality care. Aims. (i) To develop a methodology which identifies medical records of patients with a cancer diagnosis. (ii) To describe the effectiveness of search strategies to identify all patients in primary care with a cancer diagnosis compared with a diagnosis identified by a Cancer Registry. METHODS The design of the study was a retrospective analysis of primary care medical records. Five general practices were recruited in the UK. The completeness and correctness of searches were measured and compared both within the practices and compared with a diagnosis identified by a Cancer Registry. RESULTS One in five of all primary care patients with cancer was not identified when a search for all patients with cancer was conducted using electronic codes for malignancy. One in five patient records with an electronic code for a malignancy that was confirmed by registration with the Cancer Registry actually lacked the necessary documentation to verify the cancer type, date of diagnosis or any other aspect of the malignant condition. Overall, electronic codes for cancer in these medical records have a poor level of completeness (29.4%) and correctness (65.6%) when compared with the Cancer Registry. CONCLUSIONS The electronic codes in five general practices were not able to identify all patients on the practice lists with a cancer diagnosis. Practices will only be able to comply with guidelines and meet quality targets if they can identify all of their current patients with a cancer diagnosis and will require information from a Cancer Registry in order to do this.

Patients' experiences of referral for colorectal cancer

BackgroundOutcomes for colorectal cancer patients vary significantly. Compared to other countries, Australia has a good record with patient outcomes, yet there is little information available on the referral pathway. This paper explores the views of Australian patients and their experiences of referral for colorectal cancer treatment following diagnosis; the aim was to improve our understanding of the referral pathway and guide the development of future interventions.MethodsA purposive sampling strategy was used, recruiting 29 patients representing urban and rural areas from 3 Australian states who participated in 4 focus groups. Seven patients provided individual interviews to supplement the data. Recordings were transcribed verbatim, data was coded with NVivo software and analysed thematically before deductive analysis.ResultsFour aspects of the referral process were identified by patients, namely detection/diagnosis, referral for initial treatment/specialist care, the roles of the GP/specialist, and the patient’s perceived involvement in the process. The referral process was characterised by a lack of patient involvement, with few examples of shared decision-making and few examples of limited choice. However, patients did not always feel they had the knowledge to make informed decisions. Information exchange was highly valued by patients when it occurred, and it increased their satisfaction with the process. Other factors mediating care included the use of the public versus private health system, the quality of information exchange (GP to specialist and GP to patient), continuity of care between GP and specialist, and the extent of information provision when patients moved between specialist and GP care.ConclusionsPatients described poor GP continuity, ad hoc organisational systems and limited information exchange, at both interpersonal and inter-organisational levels, all leading to sub-optimal care. Implementation of a system of information feedback to GPs and engagement with them might improve information exchange for patients, enabling them to be more involved in improved referral outcomes.

The varying role of the GP in the pathway between colonoscopy and surgery for colorectal cancer: a retrospective cohort study.

Objectives To describe general practitioner (GP) involvement in the treatment referral pathway for colorectal cancer (CRC) patients. Design A retrospective cohort analysis of linked data. Setting A population-based sample of CRC patients diagnosed from August 2004 to December 2007 in New South Wales, Australia, using the 45 and Up Study, cancer registry diagnosis records, inpatient hospital records and Medicare claims records. Participants 407 CRC patients who had a colonoscopy followed by surgery. Primary outcome measures Patterns of GP consultations between colonoscopy and surgery (ie, between diagnosis and treatment). We investigated whether consulting a GP presurgery was associated with time to surgery, postsurgical GP consultations or rectal cancer cases having surgery in a centre with radiotherapy facilities. Results Of the 407 patients, 43% (n=175) had at least one GP consultation between colonoscopy and surgery. The median time from colonoscopy to surgery was 27 days for those with an intervening GP consultation and 15 days for those without the consultation. 55% (n=223) had a GP consultation up to 30 days postsurgery; it was more common in cases of patients who consulted a GP presurgery than for those who did not (65% and 47%, respectively, adjusted OR 2.71, 95% CI 1.50 to 4.89, p=0.001). Of the 142 rectal cancer cases, 23% (n=33) had their surgery in a centre with radiotherapy facilities, with no difference between those who did and did not consult a GP presurgery (21% and 25% respectively, adjusted OR 0.84, 95% CI 0.27 to 2.63, p=0.76). Conclusions Consulting a GP between colonoscopy and surgery was associated with a longer interval between diagnosis and treatment, and with further GP consultations postsurgery, but for rectal cancer cases it was not associated with treatment in a centre with radiotherapy facilities. GPs might require a more defined and systematic approach to CRC management.