Rural Adaptive Networked Colonoscopy Service

Aim

To advance equitable, sustainable access to safe, high-quality colonoscopy services for rural and remote communities through systematic upskilling and support of rural services by metropolitan centres. By enabling care closer to home, the model seeks to mitigate persistent geographic inequities.

Outcomes

A scalable, community-based model of care has been developed and successfully piloted to improve equitable access to safe, high-quality colonoscopy services in rural and remote areas. Key elements include local workforce upskilling, remote expert support, innovative endoscope reprocessing methods, and standardised clinical processes and quality assurance.

RANCS brings endoscopy services closer to home, reducing the need for long-distance travel and improving outcomes for patients who cannot or will not travel. The model enhances rural workforce capability, leverages tertiary expertise and structured protocols, and has demonstrated strong results with 5–6 patients treated per list, significant pathology managed locally, and high patient and staff satisfaction.

Background

Rural and remote communities experience persistent inequities in access to gastrointestinal diagnostics, with geographic distance, limited local infrastructure, and workforce constraints contributing to lower colorectal cancer (CRC) screening and later-stage diagnosis compared with metropolitan areas.  CRC screening is among the most effective population cancer control strategies; yet uptake in rural populations consistently lags national targets, and delays between a positive fecal test and diagnostic colonoscopy are more frequent, compounding risk for advanced disease at presentation.   Rural endoscopy is constrained by the availability of credentialed endoscopists, appropriate anaesthesia support, and compliant reprocessing facilities - factors that together limit local service provision.   In many rural areas, the distribution of specialists necessitates reliance on generalists or visiting clinicians, and even where skills exist, insufficient infrastructure and low procedure volumes impede safe, sustainable services.

Within Queensland, stakeholders identified substantial travel burden for rural patients requiring colonoscopy, often involving multiday trips to regional centres, accommodation, and time away from family and work-barriers that suppress uptake and delay care. In response, the Princess Alexandra Hospital (PAH) Department of Gastroenterology and Hepatology, working with partner Hospital and Health Services, designed the Rural Adaptive Networked Colonoscopy Service (RANCS) to bring safe, protocol-driven endoscopy closer to home. RANCS leverages tertiary expertise, shared clinical protocols, and targeted upskilling of rural clinicians, embedding a networked governance model and off-site equipment reprocessing to overcome local infrastructure constraints.  Early implementation at Cooktown demonstrates feasibility and acceptability, with completed lists delivered through cross HHS collaboration and strong community support, particularly for care provided 'on Country' for First Nations people's an equity centred outcome aligned with jurisdictional priorities. RANCS operationalises the best available evidence, strengthening rural workforce capability, and ensuring clinical governance and quality assurance are upheld through a specialist supported network. By addressing the interlocking barriers of infrastructure, workforce, and care coordination, RANCS provides a scalable pathway to reduce preventable CRC and narrow geographic gaps in gastrointestinal health outcomes across rural and remote Queensland.

A critical driver for the RANCS project was the observation of delayed cancer diagnosis due to the delay between a positive immunochemical faecal occult blood test (iFOBT) in the context of the National Bowel Cancer Screening Program (NBCSP) and timely access to diagnostic colonoscopy in rural and remote communities. Building on a three‑year program of research, the Department conducted deep consumer consultation, including in‑depth interviews and focus groups with patients, caregivers, and local clinicians. These engagements illuminated the stark realities of geographic isolation, out‑of‑pocket costs, limited local infrastructure, and fragmented referral pathways—barriers that systematically impede progression from screening to diagnosis. The findings underscored a compelling need to reorient health services toward equity by embedding networked specialist support, strengthening local workforce capability, and enabling safe care closer to home. This evidence‑informed approach directly shaped RANCS, which addresses structural constraints through coordinated governance, off‑site equipment reprocessing, and targeted upskilling.

Discussion

Pilot funding under a Federated Funding Agreement was essential to enabling and supporting the development and implementation of RANCS. The success of the service has also been strengthened by the cooperation, commitment, and networked collaboration of participating rural sites that are dedicated to delivering patient‑centred care.

The pilot implementation at Cooktown Hospital, delivered through multi-HHS collaboration, has demonstrated feasibility, strong community engagement, and high patient and staff satisfaction, highlighting its potential to reduce geographic disparities in gastrointestinal health outcomes, site equipment reprocessing and remote specialist support, enabling safe service delivery in low volume settings.   A key lesson learnt from the implementation of the RANCS Model of Care was the value of close, collaborative engagement with the rural workforce, which significantly strengthened clinical rigour and reduced workload burden by sharing responsibility for service design, system refinement, and operational problem-solving. Working alongside rural clinicians ensured that the model was adapted to local contexts, aligning processes with workforce capacity, community expectations, and cultural considerations - including care on Country - thereby enhancing feasibility and sustainability. This collaboration also improved staff confidence and ownership, creating a supportive environment for implementing new clinical pathways. While workforce fragility in rural settings - such as limited staffing, turnover, and competing clinical demands - remained a challenge, these limitations were effectively mitigated through regular communication, continuous specialist support, structured escalation pathways, and responsive adaptation of workflows.

Collectively, these lessons demonstrate that partnership-driven implementation not only improves model fidelity but also fosters a resilient, capable rural workforce equipped to deliver safe, high-quality endoscopy services.  The Model of Care is designed to be scalable to any rural site with an existing procedural or surgical space, provided the implementation is supported through networked clinical oversight and project management from a tertiary hospital. This structure enables safe, efficient adoption while minimising local resource burden.  A key initiative of the project involved designing a flexible and adaptive Model of Care capable of responding to the distinct workforce profiles, infrastructure limitations, and community needs of rural hospitals. The model was deliberately configured to accommodate variability in staffing, procedural volume, and cultural context - particularly the needs of First Nations communities - while maintaining safe clinical governance and operational efficiency. Core features such as off-site equipment reprocessing, remote specialist oversight, and adaptable workforce roles were built into the design to support feasibility in low-‘volume sites without requiring substantial capital investment.

With the success of the pilot now realised, the project implementation team has shifted its focus to comprehensive reporting, continuous quality improvement, and assessing broader scalability. Interest in adopting the model and in leveraging the networked support structures established through the pilot is now emerging across other rural sites. The team remains committed to delivering care closer to home and reducing the gap in healthcare accessibility for rural and remote populations.

References

1. Marinucci N, Koloski N, Baker K, Moy N, Holtmann G. Key recommendations to improve equity and access in colorectal cancer screening for rural and remote communities. A grounded theory study. Aust N Z J Public Health. 2025;49(6):100295.

2. Marinucci N, Moy N, Shah A, Koloski NA, Holtmann GJ. Tu1097: REIMAGINING HEALTH EQUITY AND ACCESS IN COLORECTAL CANCER SCREENING: A RURAL AND REMOTE POPULATION PERSPECTIVE. Gastroenterology. 2025;169(1):S-1307.