CREDIBLE - ColoRectal Early Diagnosis: Information Based Local Evaluation

Colorectal cancer is the UK’s third most common cancer. Lower UK survival rates compared to other countries have been linked to the fact that patients often do not present with cancer symptoms until in the relatively late disease stages.

Studies have suggested that prompt identification and referral of patients with symptoms suggestive of colorectal cancer may reduce delays between i) symptom presentation and referral; and ii) referral and diagnosis.

All GPs have electronic primary care records and these are a goldmine of clinical data with huge potential to aid primary care diagnosis of colorectal cancer.

This study is concerned with using large primary care records databases to automatically identify patients with predictive characteristics of colorectal cancer. This could lead to earlier diagnosis and better outcomes. All of the elements required for such automated identification already exist, but in the UK there is no systematic process to make use of this information. Our approach could be adapted for early diagnosis of other cancers. This method uses existing known technology at little additional cost, requires minimal change in GP behaviour and creates a direct pathway from recorded symptoms to referral.

The approach is modelled on the award-winning Sandwell Cardiovascular Risk Project. Building on the relationship with Sandwell PCT, our multiagency collaborative research will explore the feasibility of a similar approach to reduce pre-diagnostic delay for colorectal cancer.

Design

The feasibility study will generate reliable estimates of i) the number of patients who would be identified as eligible for referral; ii) the number of these that were not already under investigation; and iii) the acceptability of referral and further investigation to both patients and practitioners. These data would be used to develop the study methods for the full trial. The feasibility phase will also explore the prediction potential of different search criteria to use on the database.

From electronic primary care records we will identify patients whose recorded symptoms indicate they meet NICE criteria for urgent referral. We will determine whether these patients are already under investigation, have other known explanations for their symptoms or have declined further investigation. This will allow us to determine how many patients might benefit from further investigation. Those that are eligible will be referred for further investigation to exclude colorectal cancer.

Aim of study

To investigate the feasibility of a system of information technology prompted early referral of suspected colorectal cancer in primary care using electronic primary care records. The main objectives are:

  • To determine the proportion of patients whose electronic records show they meet NICE urgent referral criteria for suspected colorectal cancer
  • To determine the proportion of such patients who are newly referred for investigation and to describe the main reasons why patients might not be referred
  • To determine the final diagnoses ascribed to these patients
  • To investigate the acceptability of the system to participants and to GPs
  • To determine the proportion of referred patients that did not participate in the bowel cancer screening programme

Setting

Primary Care practices within Birmingham and Black Country.  

Target population

The study population is patients aged 60 to 79 registered in participating practices, without a current diagnosis of colorectal cancer.