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Implementation of a diagnostic tool for symptomatic colorectal cancer in primary care: a feasibility study

  • Nada F. Khan (a1)

Colorectal cancer is the third most common cancer in the UK. Referral guidance can help general practitioners (GPs) identify predictive symptoms of colorectal cancer at an earlier stage in primary care. The objectives of this study were to test the feasibility of a paper-based assessment tool incorporating the CAPER score, a clinical prediction rule for patients presenting to primary care with lower gastrointestinal (GI) symptoms. Three different recruitment methods and GP compliance with completing the CAPER score were assessed.


Patients aged 45 years and above consulting for bowel-related symptoms were recruited in 25 general practices in five regions in the UK. Two recruitment methods were carried out by practice receptionists and one by the GP (GP-prompted). The assessment tool prompted GPs to calculate a score using CAPER; a score of 35 points or over indicated a study referral. Three audits assessed recruitment success, compliance with the assessment tool and clinical outcomes.


In total, 122 patients were recruited into the trial. Although overall recruitment was low, GP-prompted recruitment was more successful than the other two methods. Most GPs completed a clinical examination (92.6%) as directed by the assessment tool; however, only 64% of GPs completed a rectal examination. GPs did not comply well with carrying out haemoglobin (48%) and faecal occult blood (FOB) tests (38%). Only 55% of the final CAPER scores were calculated correctly by GPs. Four patients were diagnosed with colorectal cancer; all met the referral criteria for the CAPER score; however, only three met the NICE referral criteria.


Overall, recruitment into the study was lower than expected. GP-prompted recruitment was the most effective. Assessment tool compliance was low, which indicates that in future trials a more user-friendly design should be developed.

Corresponding author
Correspondence to: Nada F. Khan, Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Oxford OX4 1PR, UK. Email:
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Primary Health Care Research & Development
  • ISSN: 1463-4236
  • EISSN: 1477-1128
  • URL: /core/journals/primary-health-care-research-and-development
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