Northern Ireland Bowel Cancer Screening Programme. Pathways. Version 4 1 st October 2013

Transcription

1 Northern Ireland Bowel Cancer Screening Programme Pathways These changes will be version controlled, led by the Quality Assurance Director for the Programme. Any updated versions will be circulated and old versions should be withdrawn. Up to date versions will be held on the Northern Ireland Bowel Cancer Screening Programme website If you would like to suggest a change please do so by contacting Dr Tracy Owen at the Quality Assurance Reference Centre (QARC) tracy.owen@hscni.net Version 4 1 st October 2013

2 Pathway 1: Invitation and Test Result... 3 Pathway 2: Referral to Assessment... 4 Pathway 3: Colonoscopy... 5 Pathway 4A: Unsuitable for Colonoscopy... 6 Pathway 4B: Radiological Investigation... 7 Pathway 5: Colonoscopy Incomplete... 8 Pathway 6: Adenoma Surveillance... 9 Pathway 7: Referral to the Colorectal Cancer Multi-disciplinary Meeting

3 Pathway 1: Invitation and Test Result Demographic source updated from NHAIS on a daily basis Weekly call list of the eligible population generated by BSIMS from demographic source Send 1 st invitation letter, bowel screening facts leaflet, instruction leaflet & FOB test kit. Test kit not within 6 weeks Reminder letter sent No response in 6 weeks GP informed, recall for FOB in 2 years from date of first invitation Test kit to laboratory FIT test, letter & FIT instruction leaflet sent Negative result Recall for FOB in 2 years from date test result. Positive result Unusable test kit spoilt (BSIMS records reason kit spoilt) FIT kit sent Equivocal Result No response in 6 weeks Reminder letter sent GP & informed Pathway 2 GP informed No response in 6 weeks letter sent to non-responder, who is to routine recall for FOB in 2 years from date of last test result. 3

4 Pathway 2: Referral to Assessment Positive Test Result Call Recall Centre notified GP informed Letter to participant asked to contact Call Recall centre Contact made, details confirmed, landline and second contact number recorded. Appointment for SSP assessment given. does not make contact reminder letter sent after 2 weeks Decline GP informed Confirmation letter sent to participant DNA Attendance at SSP appointment Not fit for Colonoscopy Fit for Colonoscopy SSP records on BSIMS. Second appointment offered according to protocol offered FOBt screen again at 2 years from date test Pathway 4A Colonoscopy Offered 2 nd DNA SSP records on BSIMS responds seeking new appointment Accepted Declined Colonoscopy appointment time and date agreed Pathway 3 4

5 Pathway 3: Colonoscopy Appointment for colonoscopy given by SSP, booked on PAS and recorded on BSIMS DNA SSP contacts participant to arrange new appointment according to protocol and records on BSIMS. Colonoscopy undertaken SSP confirms this on BSIMS 2 nd DNA. Call recall centre send appropriate letter to participant. GP Informed in writing contacts SSP to arrange new appointment SSP records on BSIMS Call recall centre checks BSIMS daily and sends all required letters. Negative Colonoscopy Complete Colonoscopy Incomplete Pathology (biopsy or polypectomy) Pathway 5 No further contact from participant SSP records on BSIMS Inform & GP Recall for FOB testing in 2 years from date test Cancer suspected / confirmed Colorectal Cancer MDT Adenoma Pathway 6 Other pathology (e.g. IBD) Appropriate Specialty Other polyp (e.g. hyperplastic) / no pathology SSP records on BSIMS Recall for FOB in 2 years from date test Inform & GP 5

6 Pathway 4A: Unsuitable for Colonoscopy Positive FOB /FIT result followed by SSP preassessment Screening Colonoscopist decides participant is unsuitable for colonoscopy assessed as temporary unfit. Reassessment planned for predetermined point in future (Difficult cases are also assessed by Screening Colonoscopist) Suitable for radiological investigation Unsuitable for radiological investigation Individual management plan agreed by screening colonoscopist CT Colonography or Double Contrast Barium Enema + / - Flexible Sigmoidoscopy offered GP Informed Recall for FOB in 2 years from date test Accept Decline Call Recall Centre sends agreed letter to participant. GP Informed in writing attends refer to pathway 4B Appointment agreed DNA New appointment arranged according to protocol. SSP records on BSIMS. 2 nd DNA No further contact from participant Recall for FOB in 2 years from date test contacts SSP to arrange new appointment. New appointment arranged according to protocol. SSP records on BSIMS 6

7 Pathway 4B: Radiological Investigation CT Colonography or Double Contrast Barium Enema +/- Flexible Sigmoidoscopy undertaken Incomplete Consider repeat once only If 2 nd incomplete procedure, refer via SSP to Screening Colonoscopist for management decision Complete Negative Cancer suspected Adenoma suspected Colonic other pathology suspected Extra colonic pathology suspected SSP record on BSIMS Screening Colonoscopist for management decision Letter sent to participant & GP informed SSP record on BSIMS Individual management plan agreed by Screening Colonoscopist (if cancer, refer to Pathway 7) Recall for FOB in 2 years from date test Inform & GP 7

8 Pathway 5: Colonoscopy Incomplete Incomplete first colonoscopy Unsuitable for second colonoscopy Second Colonoscopy undertaken Pathway 4 Colonoscopy complete Colonoscopy incomplete Pathway 3 Pathway 4 8

9 Pathway 6: Adenoma Surveillance Screen detected polyps removed colon cleared Screen detected polyps Incompletely excised Large / flat adenomas that cannot be removed at colonoscopy Low risk (1-2 adenomas, both <1cm) No surveillance recall FOBt in 2 years SSP records on BSIMS GP & informed Intermediate risk (3-4 adenomas, OR at least 1 adenoma 1cm). Colonoscopy at 3 years suspended from 2 yearly recall GP & informed. High risk ( 5 adenomas or 3 with at least one 1cm). Colonoscopy at 1 year suspended from 2 yearly recall GP & informed Repeat colonoscopy or flexible sigmoidoscopy within 3 months repeat until no residual polyp suspended from 2 yearly recall GP & informed Individual management plan agreed by Screening Colonoscopist SSP records on BSIMS Inform GP SSP records full screening history on BSIMS GP and participant informed. Recall for FOB in 2 years from date surveillance completed. 9

10 Pathway 7: Referral to the Colorectal Cancer Multi-disciplinary Me Colonoscopy Biopsy taken Polyp removed Pathology (biopsy or polypectomy) Cancer suspected/confirmed or non-resectable adenoma Result to Screening Colonoscopist & copied to SSP Presented at local colorectal MDM by Screening Colonoscopist When cancer confirmed is assigned to a named Consultant Tumour benign Call Recall Centre ceases participant from the programme Other pathology (e.g. IBD) Appropriate Specialty Adenoma Pathway 6 Other polyps (e.g. hyperplastic)/ no pathology Inform & GP according to protocol Recall for FOB in 2 years from date test Screening participants should receive their first definitive treatment within 31 days of the decision to treat being made. GP Informed 10

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