A systematic review of cancer waiting time audits

Ros Collins, M.E. Dean, P. Wilson, A. Eastwood, R. Lewis, A. Flynn, L. Myers

Research output: Book/ReportCommissioned report


OBJECTIVE: To assess the implementation and effectiveness of the two-week waiting time policy for cancer referrals and to inform a review of the cancer referral guidelines by NICE. DESIGN: Systematic review of clinical audits conducted in England and Wales. SEARCH: Key staff in all NHS Trusts, Strategic Health Authorities, Cancer Networks and relevant professional organisations in England were contacted and asked to provide details of all cancer waiting time audits conducted since 1st April 1999. Searches of the Internet and of a range of electronic databases were also undertaken. Conference proceedings were hand searched. SELECTION OF STUDIES: Obtained audit reports (sometimes only available as an abstract or slide presentation) were independently assessed for inclusion by two reviewers using predefined inclusion criteria. If an audit appeared to be relevant, but it was not possible to confirm this because information was missing, attempts were made to contact the authors. MAIN OUTCOME MEASURES: Waiting time to first appointment; GP conformity to guidelines; cancer detection (both cancer rates for populations of referrals and type of referral for populations of cancer patients); appropriateness of type of referral according to hospital clinicians; ability of the guidelines to identify correct referrals (patients meeting guidelines but who had a low suspicion of cancer, or not meeting guidelines but who had a high suspicion of cancer); process of referral (referrals received by hospital within 24 hours and mode of referral). RESULTS: 241 clinical audits meeting the inclusion criteria were identified. 193 clinical audits were classified as criterion based (i.e. where clinical practice is compared to explicit predefined criteria), 36 as non-criterion based (i.e. where practice was not compared to predefined criteria), and 12 as research studies. The majority of included studies were poorly reported. Fewer than half (44%) provided sufficient detail on the methods used for the audit to be reproducible. Under the two-week wait system, there was wide variation in the proportion of site specific cancer referrals that were seen within two weeks, in the proportion of referrals that were found to be in accordance with the symptoms listed in the guidelines, and in the proportion of two-week wait referrals deemed by consultants to warrant an urgent appointment. Less than 20% of included audits provided details outlining any recommended changes to service delivery or how any changes would be implemented. Fewer than 20% of included audits provided details of any plans to re-audit. CONCLUSIONS: Poor reporting can seriously compromise the integrity of the audit process. Audit reports should be written up in sufficient detail to allow the reader to ascertain how the audit was conducted and to assess the validity of the results and how these will be used to improve existing practices and procedures. The methods by which clinical audits of site specific cancers are conducted and reported should be standardised across the NHS.
Original languageEnglish
Place of PublicationYork, UK
PublisherUniversity of York
Number of pages127
ISBN (Print)1 900640 33 3
Publication statusPublished - Feb 2005

Publication series

NameCRD Report
PublisherUniversity of York

Bibliographical note

© 2005 Centre for Reviews and Dissemination, University of York. Available from the CRD web site.

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