In Clinical Practice

Digestive system diseases General medicine
Volume 195 - Issue 4

Referral pathways in colorectal cancer: findings from a qualitative study in general practice

Authors:  Mark F Harris, Shane W Pascoe, Lisa J Crossland, Justin J Beilby, Craig Veitch and Allan D Spigelman

Med J Aust 2011; 195 (4): 178. || doi: 10.5694/j.1326-5377.2011.tb03274.x
Published online: 15 August 2011
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To the Editor: Despite the availability of clinical guidelines,1 management of patients with colorectal cancer is variable.2 The lack of a clear referral pathway can delay this journey3 and result in patients not receiving optimal care.4 To increase our understanding of factors influencing the referral of patients with colorectal cancer from general practice to specialists, we examined the views of 19 general practitioners in four focus groups — held in rural and urban New South Wales, rural Queensland, and urban South Australia.

The relationships of these GPs with specialists not only helped expedite referral but also improved quality of care and feedback. The GPs considered that direct personal contact enhanced their relationships with specialists. This was cultivated over time and was seen as a measure of the GPs’ commitment to getting the best care for their patients. This was especially important for the GPs in rural and remote areas who advocated for patient needs, including travel for diagnosis and treatment and completion of follow-up care. The GPs felt that influencing the referral process required overcoming barriers within the public health system and/or facilitating referral to private providers. GPs preferred referral to the private health services compared with referral to the public system because of perceived delays and communication difficulties in the public system.

GPs described a system of referral that was ad hoc and not informed by best practice guidelines or outcomes. They were most influenced by the ease of access to appropriate and timely consultations and the quality of feedback from specialists. Although this works well much of the time, we need a system in the public and private health sectors that identifies patients who may have cancer, investigates and treats them in a timely fashion, and delivers care that meets optimal standards. As patients of surgeons with higher caseloads tend to have better outcomes,5 GPs need better information about surgeon caseload. Finally, as we increasingly move towards working in multidisciplinary teams, it would be useful for GPs to have information regarding other support staff linked to surgeons.

Authors

  • Mark F Harris1
  • Shane W Pascoe1
  • Lisa J Crossland2
  • Justin J Beilby3
  • Craig Veitch4
  • Allan D Spigelman5
  • 1. Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW.
  • 2. Discipline of General Practice, Royal Brisbane Hospital, Brisbane, QLD.
  • 3. Faculty of Health Sciences, University of Adelaide, Adelaide, SA.
  • 4. University of Sydney, Sydney, NSW.
  • 5. University of New South Wales, Sydney, NSW.

Correspondence: m.f.harris@unsw.edu.au

Acknowledgements

We acknowledge Dianne O’Connell, David Goldsbury, Michael Barton, Ian Olver and John Stubbs, who are co-investigators on the study team. We also thank Cancer Australia for providing funding for this project; the Riverina Division of General Practice and Primary Health, Macarthur Division of General Practice, Adelaide Western General Practice Network, and Rural Doctors Association of Queensland for assisting with recruitment of study participants; and Jackie Street for assisting with data collection.

References

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