Application of Duty of Candour legislation in post-colonoscopy colorectal cancer: a prospective cohort study

• Published in: Endoscopy
• Main Authors: Saunsbury, Emma, Burr, Nicholas E, Beaton, David, McSweeney, Kate, Mason-Higgins, Jo, Trudgill, Nigel, Morris, Eva Judith Ann, Valori, Roland
• Format: Journal Article
• Language: English
• Published: Germany 16.10.2024
• ISSN: 1438-8812
• DOI: 10.1055/a-2443-0332

Background & Study Aims The study investigates the application of Duty of Candour (DoC) legislation in the context of post-colonoscopy colorectal cancers (PCCRCs). DoC mandates transparent disclosure of notifiable safety incidents to patients in the English National Health Service, including those leading to severe or moderate harm. This study aims to analyse the application of DoC in PCCRCs, improve understanding of the legislation and identify challenges in its implementation. Patients & Methods A national audit of PCCRCs was conducted between September 2021 to May 2022. PCCRCs were identified using linked administrative datasets and root-cause analyses were performed using a structured template. 1,724 PCCRCs were included. 'Avoidability' and harm categorised into specific levels, with guidance provided to improve consistency in judgments. Results 16% of PCCRCs resulted in major harm or death, of which 27%(75) were at least probably avoidable. Hospitals deemed DoC discharge necessary in only 53% of these cases. When including moderate harm, 11% of all PCCRCs would trigger DoC discharge, yet this was deemed necessary in only 41% of these cases. Conclusions There is inconsistent application of DoC in PCCRC cases. Challenges include determining 'avoidability' and harm, particularly when there is a delay in diagnosis. Clearer guidance and definitions of harm are needed to improve adherence to regulations.