Appropriate and timely colonoscopy

Quality statement 2

A patient is offered timely colonoscopy when appropriate for screening, surveillance, or the investigation of signs or symptoms of bowel disease, as consistent with national evidence-based guidelines. Decisions are made in the context of the patient’s ability to tolerate the bowel preparation and colonoscopy, and their likelihood of benefit. If colonoscopy is not appropriate, the receiving clinician advises the patient and their referring clinician of alternate recommended management.

Purpose

To ensure colonoscopy is offered to patients who are most likely to benefit from the procedure and within a timeframe concordant with their risk, in a manner consistent with current national evidence-based guidelines.

For consumers

Colonoscopy is used when doctors want to look at the inside of the bowel to check for signs of disease. It may be recommended if you are experiencing certain bowel problems, to follow up a previous bowel condition, because of test results (such as a CT scan or FOBT) or your family history.
You should only be offered a colonoscopy if the benefits outweigh any risks of the procedure for you. While most people do not have any complications, the bowel preparation, the sedation and the colonoscopy all have some risks. Your doctor or nurse will discuss these risks with you, considering your general health. You should also talk about the risks of not having the colonoscopy.
For some people a colonoscopy may need to be carried out as soon as possible, while for other people it may just need to be done less urgently. If a colonoscopy is not recommended then the doctor may suggest an alternative test.

For clinicians

Consider whether colonoscopy is indicated for the patient according to national evidence-based guidelines and the epidemiology of colonic disease. Assess the likely benefits to the patient, as well as the risks associated with the bowel preparation, sedation, the procedure itself, and the risks associated with not having the procedure.

For people with symptoms suggestive of bowel cancer or a positive immunochemical FOBT, refer to Cancer Council Australia’s Clinical practice guidelines for the prevention, early detection and management of colorectal cancer 8, and the recommended triage criteria to ensure prompt scheduling for patients.
For people requiring surveillance colonoscopy, refer to the current version of Cancer Council Australia’s Clinical Practice Guidelines for Surveillance Colonoscopy 9 regarding the frequency and surveillance intervals for colonoscopy in high-risk individuals.

If colonoscopy is not appropriate, advise the patient and their referring clinician about recommended alternative diagnostic strategies or management.

For health service organisations

Ensure that policies and processes support the timely and appropriate provision of colonoscopy. This includes:

Supporting and promoting clinicians’ use of national evidence-based guidelines including Cancer Council Australia’s Clinical practice guidelines for the prevention, early detection and management of colorectal cancer, and current Clinical Practice Guidelines for Surveillance Colonoscopy
Supporting and encouraging clinician participation in quality improvement and peer-review processes.

For health service organisations that receive referrals, reflect guideline recommendations from the Cancer Council Australia in policies and procedures for triage and scheduling of colonoscopy appointments.

For consumers

Colonoscopy is used when doctors want to look at the inside of the bowel to check for signs of disease. It may be recommended if you are experiencing certain bowel problems, to follow up a previous bowel condition, because of test results (such as a CT scan or FOBT) or your family history.
You should only be offered a colonoscopy if the benefits outweigh any risks of the procedure for you. While most people do not have any complications, the bowel preparation, the sedation and the colonoscopy all have some risks. Your doctor or nurse will discuss these risks with you, considering your general health. You should also talk about the risks of not having the colonoscopy.
For some people a colonoscopy may need to be carried out as soon as possible, while for other people it may just need to be done less urgently. If a colonoscopy is not recommended then the doctor may suggest an alternative test.

For clinicians

For people with symptoms suggestive of bowel cancer or a positive immunochemical FOBT, refer to Cancer Council Australia’s Clinical practice guidelines for the prevention, early detection and management of colorectal cancer 8, and the recommended triage criteria to ensure prompt scheduling for patients.
For people requiring surveillance colonoscopy, refer to the current version of Cancer Council Australia’s Clinical Practice Guidelines for Surveillance Colonoscopy 9 regarding the frequency and surveillance intervals for colonoscopy in high-risk individuals.

If colonoscopy is not appropriate, advise the patient and their referring clinician about recommended alternative diagnostic strategies or management.

For health service organisations

Ensure that policies and processes support the timely and appropriate provision of colonoscopy. This includes:

Supporting and promoting clinicians’ use of national evidence-based guidelines including Cancer Council Australia’s Clinical practice guidelines for the prevention, early detection and management of colorectal cancer, and current Clinical Practice Guidelines for Surveillance Colonoscopy
Supporting and encouraging clinician participation in quality improvement and peer-review processes.

Read Quality Statement 3 - Informed decision making and consent

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