Scottish referral guidelines for suspected cancer: quick reference guide

Patient issues

Patients’ and carers’ needs

All healthcare professionals should be sensitive to the needs of patients, carers and relatives when cancer is suspected. Realistic Medicine^[1] is the Scottish Government’s initiative to put the person at the centre of decision-making and encourages a personalised approach to their care. Good communication is key and five questions to be considered by all involved can help lead to informed decision-making:

• Is this action really needed?
• What are the benefits and risks?
• What are the possible side effects?
• Are there alternative options?
• And, importantly, what would happen if we did nothing?

Good practice includes:

• Being sensitive to the person’s wishes to be involved in decisions about their care
• Providing understandable information at a level appropriate to the person’s wishes to be informed
• Being aware of, and offering to provide access to, sources of information in various formats
• Using the word “cancer” as a reason for investigation or referral unless there is serious concern about causing unwarranted distress
• Providing information about any referral to other services in format(s) most suitable for the person, including how long they might have to wait, who they are likely to see, and what is likely to happen to them
• Considering carefully the need for emotional and physical support while awaiting an appointment with a specialist and, where appropriate, providing a key contact
• Considering any carers’ needs for support and information, taking issues of confidentiality into consideration
• Taking the individual’s particular circumstances into account, for example age, family, work and culture
• Recognising that there are occasions when intrusive intervention is not in a person’s best interests. There should be full discussion about alternative approaches, including with relevant others if a person lacks capacity, complying with the Adults with Incapacity (Scotland) Act 2000
• Maintaining a high standard of communication skills, including, for example, in the process of breaking bad news

Referral Process

General Points

Recent evidence has identified thrombocytosis as a strong risk marker for malignancy, in particular lung, endometrial, gastric, oesophageal and colorectal cancer (acronym “LEGO-C”). With a cancer incidence of 11.6% and 6.2% in males and females respectively, these figures well exceed the 3% threshold to warrant investigation^[2]

It is good practice to include general fitness or performance status in the referral (e.g. ECOG/WHO scale) in order to facilitate discussion about the most appropriate pathway (see Appendix for ECOG/WHO scale)