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Setting up a nurse-led bowel ‘two week wait’ service

12 September 2019
Volume 28 · Issue 16


Patients who present to their GP with ‘red flag’ symptoms for possible bowel cancer (such as change in bowel habit or rectal bleeding) are urgently referred to an acute trust as a ‘2 week wait’ (2WW) patient and require assessment and investigation in an efficient and timely manner. The burden that is created by ever increasing numbers of referrals requires a service that is reliable and flexible in meeting demand. This article presents the development of a nurse-led 2WW service that was implemented as a direct result of this pressure. The development of the national guideline is discussed and the rationale for a nurse-led service is provided, along with the processes followed to ensure patient safety. The inclusion of a telephone side to service provision is also examined and the challenges faced by the team are discussed.

In the UK, around 42 000 people are diagnosed with bowel cancer each year. Associated risk factors, such as obesity and poor diet, are prevalent in the UK but patients who receive an early diagnosis (stage 1) have a more than 90% survival rate at 5 years. This drops significantly to less than 10% in those diagnosed at the latest stage (stage 4) (Cancer Research UK, 2019). With the emphasis on early detection, the Government produced a White Paper in 1997, stating the intention that by 2000 all patients assessed by a GP with a suspicion of bowel cancer should be referred to and seen by a specialist team within 14 days (Department of Health (DH), 1997). This would be vital to ensure that the NHS Cancer Plan targets of 62 days between referral and first treatment and 31 days to treatment after diagnosis could be met (DH, 2000) and led to the development of the ‘two week wait’ (2WW) clinic.

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