The two-week rule for suspected colorectal cancer: patient experience and psychological impact

Int J Health Care Qual Assur. 2012;25(1):75-85. doi: 10.1108/09526861211192421.


Purpose: There has been considerable interest in the "two-week rule" referral pathway efficacy for patients with suspected colorectal cancer. This study aims to explore the psychological impact on these patients.

Design/methodology/approach: Consecutive patients referred for urgent investigations under the "two-week rule" were invited to take part in semi-structured interviews using interpretative phenomenological analysis (IPA). Interviews were audio-taped, transcribed verbatim and analysed using investigator triangulation to enhance data trustworthiness.

Findings: Ten out of 23 (43.5 per cent) patients consented to interviews; none were diagnosed with cancer. Four super-ordinate themes were explored, referring to the "making sense of the threat to health", impact on self, impact on others, reflections on the "two-week rule" referral, and its investigative process. Participants reported their anxiety, fear, vulnerability and coping mechanisms, but also raised concerns about the communication received during the "two-week rule" referral process. Female participants preferred a female endoscopist.

Originality/value: This study is the first of its kind exploring the psychological effects of the "two-week rule" process for colorectal cancer, highlighting potential areas for improvement in patient information, and satisfaction with the referral process.

MeSH terms

  • Adaptation, Psychological*
  • Adult
  • Aged
  • Anxiety / psychology*
  • Colorectal Neoplasms / psychology*
  • England
  • Fear / psychology*
  • Female
  • Humans
  • Interviews as Topic
  • Male
  • Middle Aged
  • Prospective Studies
  • Qualitative Research
  • Referral and Consultation
  • Time Factors
  • Waiting Lists