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Addressing unwarranted variations in colorectal cancer outcomes: a conceptual approach

Nature Reviews Clinical Oncology volume 13, pages 706–712 (2016)Cite this article

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Abstract

In the clinical setting, the term 'unwarranted variation' refers to variations in patient outcomes that cannot be explained by the patient's underlying illness or medical needs, or the dictates of evidence-based medicine. These types of variations persist even after adjusting for patient-specific factors. Unwarranted variation depends on a complex mix of disparities, including inequalities in access to appropriate care in a wide variety of geographical and cultural settings, in the uptake and application of clinical knowledge, in the prioritization and allocation of resources, and differences in organizational and professional culture. Nevertheless, unwarranted variation has been inexorably linked with clinical practice. Thus, awareness of the antecedents of unwarranted variations in clinical practice is strategically important. In this Perspective, we discuss these antecedents in colorectal cancer clinical care pathways with an emphasis upon the multidisciplinary team (MDT), and suggest pragmatic steps that could be taken to address latent unwarranted variation.

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Figure 1: Conceptual example of risk scoring of unwarranted variation along critical clinical nodes of a broad rectal cancer emergency care pathway.
Figure 2: Conceptual example of risk scoring of unwarranted variation along critical care nodes of a broad rectal cancer elective care pathway.

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Authors and Affiliations

  1. Muralee Menon and David Kerr are at the Nuffield Division of Clinical and Laboratory Science, Radcliffe Department of Medicine, Level 4, Academic Block, John Radcliffe Hospital, Headley Way, Oxford OX3 9DU, UK.,

    Muralee Menon & David Kerr

  2. Chris Cunningham is at the Department of Colorectal Surgery, Cancer Centre, Churchill Hospital, Oxford University Hospital NHS Foundation Trust, Old Road, Headington, Oxford OX3 7LE, UK.,

    Chris Cunningham

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M.M. researched data for the article, all authors made substantial contributions to discussions of content, M.M. wrote the manuscript, and all authors reviewed and edited the manuscript prior to submission.

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Correspondence to Muralee Menon.

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Menon, M., Cunningham, C. & Kerr, D. Addressing unwarranted variations in colorectal cancer outcomes: a conceptual approach. Nat Rev Clin Oncol 13, 706–712 (2016). https://doi.org/10.1038/nrclinonc.2016.94

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