Colorectal cancer vignettes: guideline adherence and definitive action
| UK | Europe | Canada | Australia | |||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Wales | Northern Ireland | England | Denmark | Norway | Sweden | Manitoba | Ontario | New South Wales | Victoria | |
| 1-year colorectal cancer survival, % | 73.6 | 76.2 | 74.7 | 77.7 | 82.4 | 83.8 | 82.1 | 83.9 | 84.7 | 85.1 |
| Vignette 3 summary: 43-year-old female, diarrhoea predominant IBS with an increase in colicky, abdominal pain during the day, unresponsive to antispasmodic, no change in bowel habit or weight loss, 5-day regular (not heavy) periods (PPV 0.7%) | ||||||||||
| Definitive action taken by clinician, % | 7 | 15 | 7 | 44 | 31 | 38 | 44 | 25 | 42 | 33 |
| % (95% CI) | 8 (5 to 11) | 34 (31 to 37)a | ||||||||
| Action recommended by guideline | FBC | FBC | FBC | Referral | FBC | NDG | No guideline | FBC | C or R | C or R |
| Adherence to guideline, % | 38 | 50 | 51 | 33 | 64 | – | – | 54 | 39 | 29 |
| % (95% CI) | 45 (40 to 51) | 46 (42 to 49)b | ||||||||
| Vignette 4 summary: 68-year-old male, loose stools for 4 weeks, normal examination, no significant history (PPV 0.9%) | ||||||||||
| Definitive action taken by clinician, % | 17 | 16 | 15 | 37 | 21 | 23 | 30 | 25 | 27 | 33 |
| % (95% CI) | 16 (11 to 22) | 27 (23 to 31)a | ||||||||
| Action recommended by guideline | FBC | FBC | FBC | Referral | FBC | SC | No guideline | FBC | C or R | C or R |
| Adherence to guideline, % | 64 | 68 | 68 | 20 | 74 | 20 | – | 57 | 27 | 33 |
| % (95% CI) | 67 (60 to 74) | 38 (34 to 43)a | ||||||||
↵a P<0.05 for difference between UK and non-UK jurisdictions.
↵b P = 0.73 for difference between UK and non-UK jurisdictions.
C or R = colonoscopy or referral. FBC = full blood count, complete blood count, or blood haemoglobin. IBS = irritable bowel syndrome. NDG = not defined in guideline. PPV = positive predictive value. SC = specialist colonoscopy.