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

Emma Saunsbury; Nicholas E. Burr; David Beaton; Kate McSweeney; Jo Mason-Higgins; Nigel Trudgill; Eva J. A. Morris; Roland Valori

doi:10.1055/a-2443-0332

Endoscopy, Table of Contents

Endoscopy 2025; 57(04): 361-365
DOI: 10.1055/a-2443-0332

Innovations and brief communications

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

Emma Saunsbury‡

¹Department of Gastroenterology, Somerset NHS Foundation Trust, Taunton, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN7852)

,

Nicholas E. Burr ‡

²Department of Gastroenterology, Mid-Yorkshire Hospitals Teaching NHS Trust, Wakefield, United Kingdom of Great Britain and Northern Ireland

,

David Beaton

³Department of Gastroenterology, Northumbria NHS Foundation Trust, Newcastle upon Tyne, United Kingdom of Great Britain and Northern Ireland

,

Kate McSweeney

⁴Bowel Cancer Intelligence UK Patient-Public Group, Oxford, United Kingdom of Great Britain and Northern Ireland

,

Jo Mason-Higgins

⁵Complaints, Claims and Patient Safety Investigations, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom of Great Britain and Northern Ireland (Ringgold ID: RIN2379)

,

Nigel Trudgill

⁶Department of Gastroenterology, Sandwell and West Birmingham NHS Trust, West Bromwich, United Kingdom of Great Britain and Northern Ireland

⁷Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom of Great Britain and Northern Ireland

,

Eva J. A. Morris

⁸Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom of Great Britain and Northern Ireland

,

Roland Valori

⁹Department of Gastroenterology, Gloucestershire Hospitals NHS Foundation Trust, Gloucester, United Kingdom of Great Britain and Northern Ireland

› Author Affiliations

Abstract

Background

This study investigated 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 incidences leading to severe or moderate harm. This study aimed to analyze the application of DoC in PCCRCs, improve understanding of the legislation, and identify challenges in DoC implementation.

Methods

A national audit of PCCRCs was conducted between September 2021 and May 2022. PCCRCs were identified using linked administrative datasets, and root-cause analyses were performed using structured templates. “Avoidability” and harm were categorized into specific levels, and guidance was provided on improving consistency in judgments.

Results

16% of 1724 PCCRCs resulted in major harm or death, of which 27% (75) were probably or definitely 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 45% of such cases.

Conclusions

There is inconsistent application of DoC in PCCRC cases. Challenges include determining “avoidability” and harm, particularly when diagnosis is delayed. Clearer guidance and definitions of harm are needed to improve adherence to regulations.

Full Text

References

References
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Supplementary Material

Supplementary Material