Initial assessment and referral

• People might have a colonoscopy for different reasons and every person’s situation is different. Just because you are referred to a specialist to consider having a colonoscopy does not mean that it will be the right thing for you.
• It is important that the doctor or health service organisation that you are referred to has the right information about you and your medical history. This will help them decide if a colonoscopy is likely to help you.
• Your current and past medical conditions, your age, your family medical and cancer history, current medicines and the results of previous tests, imaging and colonoscopies should all be included in the referral document. In some health service organisations, the referral is also used to decide how soon to book your appointment.
• The doctor who writes the referral will explain what you need to do next, how soon you need the appointment and what to do if you are not given an appointment within that time.

When referring patients for consideration of colonoscopy, provide a comprehensive referral to prevent delays and enable accurate assessment of the patient’s suitability for colonoscopy. Standard (electronic) templates can help, for example those included in local Health Pathways. The referral should include:

• The indication for the referral including presenting symptoms and the preliminary diagnosis
• All relevant medical and family history, including of bowel and other cancers, known genetic predispositions
• Current medicines and other medical conditions.
• Previous relevant treatment
• Results of previous investigations, including of FOBT (indicating whether this was through the NBCSP), colonoscopies and histopathology.

Consider the indications and surveillance intervals recommended in current evidence-based guidelines such as the Cancer Council Australia’s Clinical practice guidelines for the prevention, early detection and management of colorectal cancer (2017) and Clinical Practice Guidelines for Surveillance Colonoscopy (2018), the patient’s co-morbidities and the patient’s willingness to proceed. Advise the patient that the specialist receiving the referral will assess them individually before undertaking the colonoscopy. Provide clear instructions to the patient on what they need to do to act on the referral, the degree of urgency, and what to do if they cannot get an appointment in the recommended timeframe.

For clinicians receiving referrals, ensure that there are processes for allocating appointments according to clinical need.

For health service organisations that refer patients, use consistent processes for referring patients for colonoscopy to ensure that referrals are comprehensive and accurate.

For health service organisations receiving, allocating or prioritising referrals for clinical assessment or colonoscopy (including open access services) ensure that clear referral guidelines are available for referring clinicians, identifying the type and format of clinical information required. Use of this information will support the provision of services according to patient’s clinical priority. Using agreed, standardised templates can assist the communication of important information between referring clinicians and colonoscopy services; these may be in electronic format.