Faster and more accurate diagnosis of patients with symptoms of bowel disease
Accurate diagnosis of patients presenting with bowel disease currently involves several tests and procedures that can be time consuming and expensive for patients and clinicians.
This project aims to develop an accessible, easy-to-use assessment tool to better manage patients presenting to their general practitioner (GP) with symptoms of bowel disease.
It will aim to accelerate treatment for high-risk patients, where any significant delays in diagnosis can lead to complications. Successful implementation of such a tool will lead to improvements in triaging of GP referrals by specialist nurses and medical staff, and more accurate prioritisation of colonoscopies. This will result in an increase in early colonoscopy for high-risk patients and appropriate timing of colonoscopy or alternative management strategies for low/no-risk patients, leading to a more efficient use of resources for colonoscopy than the current standard practice.
By achieving these outcomes with implementation of the assessment tool, the project team hopes to achieve earlier detection of colorectal cancer, advanced precancerous lesions and inflammatory bowel diseases, leading to better outcomes for patients.
The first study included a test cohort of 467 patients and led to the development of a published algorithm forming the basis of the project’s phase 1 risk assessment tool.
Results showed that the test algorithm outperforms a faecal occult blood test by a factor of 2.
The components making up the algorithm to date are often requested in primary health care as part of routine clinical practice.
‘Pulling in’ recent pathology data on any given patient to support the tool in the future is feasible.
Funding allowed for the expansion of the initial study, with the aim of recruiting an additional 600 study participants across three sites: Royal Brisbane and Women’s Hospital (RBWH), The Prince Charles Hospital (TPCH) and Queen Elizabeth II Jubilee Hospital (QEII). COVID-19 has impacted significantly on this recruitment through 2020 and 2021. However, two of three sites (RBWH and TPCH) have restarted recruitment and this is progressing well.
To date, a total of 228 study participants have been recruited through the MRFF-funded project, contributing to a total of 366 in the validation cohort. A further 234 patients will be required to complete the validation cohort.
The tool remains under development and requires rigorous further assessments before it can be considered for clinical practice. The longer term objective is for the tool to be available in the primary care setting to assist GPs in their management of patients presenting with abdominal symptoms. To this end, the project team is setting up focus groups that include patients, hospital nurses, specialist medical staff and GPs to discuss the potential value and acceptability of such a tool. A project target is to complete the focus group discussion.
The next steps are to validate the tool in our second cohort and seek funding to support a randomised clinical trial assessing the acceptability and accuracy of the tool in real world clinical practice.
Trial statistics – please refer to the publication (Lord A, et al. Development and evaluation of a risk assessment tool to improve clinical triage accuracy for colonoscopic investigations. BMC Cancer 2018; 18(1): 229 (PMID: 29486733)).
Project investigators engage with and draw up on the expertise of partners within universities, research institutes, and hospital and health services around Queensland.
Dr Graham Radford-Smith, Group Leader, QIMR Berghofer Medical Research Institute (Lead)
Dr Tony Rahman, Director, Department of Gastroenterology, TPCH
Dr Nick Tutticci, Director, Department of Gastroenterology, QEII Hospital
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