Quality standard

Quality statement 3: Testing for blood in faeces

Quality statement 3: Testing for blood in faeces

Quality statement

Adults presenting in primary care with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, have a test for blood in their faeces.

Rationale

Many colorectal cancers leak blood into the bowel intermittently. Tests for the presence of blood in faeces are relatively easy, inexpensive and safe, and help to identify people at higher risk of having colorectal cancer. People at higher risk can then receive definitive investigation sooner, resulting in earlier treatment for those diagnosed with cancer.

Quality measures

The following measures can be used to assess the quality of care or service provision specified in the statement. They are examples of how the statement can be measured and can be adapted and used flexibly.

Structure

Evidence of local arrangements and written clinical protocols to ensure that adults presenting in primary care with symptoms that suggest colorectal cancer who do not meet the referral pathway criteria, have a test for blood in faeces.

Data source: Local data collection.

Process

Proportion of presentations of adults with symptoms that suggest colorectal cancer, without visible rectal bleeding, in which the person has a test for blood in faeces.

Numerator – the number in the denominator resulting in a test for blood in faeces.

Denominator – the number of presentations of adults with symptoms that suggest colorectal cancer who do not meet the referral pathway criteria.

Data source: Local data collection.

Outcome

a) Stage of colorectal cancer at diagnosis.

Data source: Local data collection.

b) Colorectal cancer-related mortality.

Data source: Local data collection.

What the quality statement means for different audiences

Service providers (primary care services) ensure that systems are in place for adults with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, to have a test for blood in their faeces.

Healthcare professionals (GPs, specialists and practice nurses) ensure they offer a test for blood in their faeces to adults presenting in primary care with symptoms that suggest colorectal cancer who do not meet the referral pathway criteria.

Commissioners (clinical commissioning groups and NHS England) ensure that they commission services in which people presenting in primary care with symptoms that suggest colorectal cancer, who do not meet the referral pathway criteria, have a test for blood in their faeces.

Adults who have certain symptoms that might be caused by cancer of the colon or rectum, should be offered a test to check for traces of blood in their faeces. This will check if the person is at risk of cancer, and may help to diagnose it early.

Definitions of terms used in this quality statement

Adults with symptoms that suggest colorectal cancer who do not need an urgent referral

Adults with unexplained symptoms of colorectal cancer (for example, weight loss, abdominal pain, iron-deficiency anaemia and changes in bowel habit) who do not have rectal bleeding and do not meet the criteria for a suspected cancer pathway referral outlined in NICE's guideline on suspected cancer (recommendations 1.3.1 to 1.3.3). [Adapted from NICE diagnostics guidance on quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care and NICE's guideline on suspected cancer, recommendation 1.3.4]

Test for blood in faeces

A chemical test that can pick up the presence of tiny traces of blood in faeces. NICE recommends OC Sensor, HM-JACKarc and FOB Gold quantitative faecal immunochemical tests for adoption in primary care. [NICE diagnostics guidance on quantitative faecal immunochemical tests to guide referral for colorectal cancer in primary care]