Reasons for missed or delayed colorectal cancer follow-up as ascertained by record review
| Colorectal cancer triggers | FOBT-based trigger n=78 | IDA-based trigger n=120 | Haematochezia-based trigger n=60 |
|---|---|---|---|
| Reason | Total records # (%) | Total records # (%) | Total records # (%) |
| Justification documented (false positives) | |||
| Patient declined colonoscopy | 3 (11.5) | 2 (5.1) | 7 (28.0) |
| Patient pursued outside care | 2 (7.7) | 5 (12.8) | 1 (4.0) |
| Record identified by trigger despite not meeting Red flag criteria (data miscoded) | 0 (0.0) | 0 (0.0) | 13 (52.0) |
| Patient identified by trigger despite meeting exclusion or expected follow-up criteria | 21 (80.8) | 32 (82.1) | 4 (16.0) |
| Upper GI bleed identified as bleeding source | 4 | 17 | 0 |
| Prior colonoscopy performed at outside institution | 10 | 8 | 2 |
| Patient hospitalised at time of red flag diagnostic clue | 0 | 6 | 0 |
| Terminal illness/hospice care | 2 | 0 | 2 |
| Other | 5 | 1 | 0 |
| Total with justification documented | 26 (33.3) | 39 (32.5) | 25 (41.7) |
| No justification documented (true positives) | |||
| No reason/rationale documented | 15 (28.8) | 72 (88.9) | 18 (51.4) |
| Colonoscopy ordered by not performed by 60 days | 34 (65.4) | 4 (4.9) | 12 (34.3) |
| Inadequate follow-up (eg, subsequent FOBT only) | 3 (5.8) | 5 (6.2) | 5 (14.3) |
| Total without justification documented (PPV) | 52 (66.7) | 81 (67.5) | 35 (58.3) |
FOBT, faecal occult blood test; GI, gastrointestinal; IDA, iron deficiency anaemia; PPV, positive predictive value.