Introduction National Colorectal Family History Screening guidelines categorise risk based on incidence of familial cancer, type of cancer, age and genetic proximity. High and Medium risk patients are recommended regular or one off screening colonoscopies. Appropriate assessment of risk involves obtaining detailed, relevant and accurate family history information. Incorrect assessment of risk can result in High/Medium risk patients not receiving tests or Low risk patients being subjected to unnecessary invasive and costly colonoscopies. The majority of asymptomatic referrals to the Nurse led CFHSC are from primary care. The family history information supporting referral provided by GP’s is non-standardised. Data provided can often be inaccurate for such reasons as; patients quote the wrong types of cancer, do not relate non bowel associated cancers, mistaking other benign bowel disorders for malignant disorders, and include distant family or family beyond age thresholds. The CFHSC expends significant resource in improving the accuracy and relevance, with respect to guidelines, of the family history information. This is done via a patient questionnaire then verification against medical records and cancer registry. This study aims to quantify the benefits of this verification process.
Methods All consecutive GP referrals from Jan 2012 to end of Dec 2012 to the Nottingham Nurse led CFHSC were included in this study. Risk based on the family history data was assessed at three sources; based purely on GP information, based on patient questionnaire and finally following verification with the cancer registry and medical notes. Performance of GP referral and patient reported information was compared with the verified history using Chi Squared test.
Results 54 patients were included in the study. Using GP referral information alone categorised 12 high, 12 upper moderate, 30 lower moderate and no low risk of familial colorectal cancer. Using the patient reported family history screening questionnaire data resulted in 10 high, 11 upper moderate and 29 lower moderate and 4 low risk patients. Final verification with medical records resulted in 8 high, 9 upper moderate, 27 lower moderate and 10 low risk patients. Thus there was a significant reduction in number of colonoscopies required following verification of the family history with 10 (18.5%, Chi Squared 11.4, p < 0.01) patients no longer requiring a colonoscopy based on their confirmed family history data compared with the GP history.
Conclusion The verification process adds significant value in reducing patient risk and preventing unnecessary screening procedures with an overall 18.5% reduction in colonoscopies requested compared to relying solely on the GP history.
Disclosure of Interest None Declared.
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