General practitioners’ awareness of the recommendations for faecal immunochemical tests (FITs) for suspected lower gastrointestinal cancers: a national survey

Wagner, Christian von; Stoffel, Sandro; Freeman, Madeline; Laszlo, Helga E; Nicholson, Brian D; Sheringham, Jessica; Szinay, Dorothy; Hirst, Yasemin

doi:10.1136/bmjopen-2018-025737

Cited by 5 publications

(5 citation statements)

References 21 publications

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“…Accordingly, three times fewer false‐positive tests are reported when FIT is compared to gFOB in samples sent to the laboratory for symptomatic patients 10 . The adoption of FIT in primary care has been slow with notable variation in uptake and implementation across England, 5 low awareness of the NICE guidance 11 and low confidence in the accuracy of FIT amongst general practitioners (GPs) 12 . The public report a preference for FIT over colonoscopy if no additional cancers are missed 13 …”

Section: Introductionmentioning

confidence: 99%

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

Nicholson

James

Paddon

et al. 2020

Aliment Pharmacol Ther

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Summary Background Faecal immunochemical testing (FIT) is recommended by the National Institute for Health and Care Excellence (NICE) to triage symptomatic primary care patients for further investigation of colorectal cancer. Aim To ascertain the diagnostic performance of FIT in symptomatic adult primary care patients. Methods Faecal samples from routine primary care practice in Oxfordshire, UK were analysed using the HM‐JACKarc FIT method between March 2017 and March 2020. Clinical details were recorded. Patients were followed for up to 36 months in linked hospital records for evidence of benign and serious (colorectal cancer, high‐risk adenomas and bowel inflammation) colorectal disease. The diagnostic accuracy of FIT is reported by gender, age group and FIT threshold. Results In 9896 adult patients with at least 6‐month follow‐up, a FIT result ≥10 µg Hb/g faeces had a sensitivity for colorectal cancer of 90.5% (95% CI 84.9%‐96.1%), specificity 91.3% (90.8%‐91.9%), positive predictive value (PPV) 10.1% (8.15%‐12.0%) and negative predictive value (NPV) 99.9% (99.8%‐100.0%). The PPV and specificity for serious colorectal disease were higher and the sensitivity and NPV lower than for colorectal cancer alone. The area under the curve for all adults did not change substantially by gender or by increasing the minimum age of testing. Using ≥10 µg Hb/g faeces, 10% of adults would be investigated to detect 91% of cancers, a number needed to scope of ten to detect one cancer. Using ≥7, ≥50 and ≥150 µg Hb/g faeces, 11%, 4% and 3% of adults would be investigated, and 91%, 74% and 54% cancers detected, respectively. Conclusion A FIT threshold of ≥10 µg Hb/g faeces would be appropriate to triage adult patients presenting to primary care with symptoms of serious colorectal disease. FIT may be used to reprioritise patients referred with colorectal cancer symptoms whose investigations have been delayed by the COVID‐19 pandemic.

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Section: Introductionmentioning

confidence: 99%

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

Nicholson

James

Paddon

et al. 2020

Aliment Pharmacol Ther

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“…Consenting GPs were provided with information about the current NITAG recommendation and asked whether they recognised the NITAG recommendation on vaccinating adults (“Before today, were you aware of the recommendation for vaccinating adults with known risk factors for invasive pneumococcal disease?”) and whether they recalled all risk groups for which the PCV13 vaccination is recommended (“Were you aware of all the risk patients, for which the pneumococcal vaccine is recommended?”) [ 25 ]. Both questions featured dichotomous (Yes/No) response options.…”

Section: Methodsmentioning

confidence: 99%

“…and whether they recalled all risk groups for which the PCV13 vaccination is recommended ("Were you aware of all the risk patients, for which the pneumococcal vaccine is recommended?") [25]. Both questions featured dichotomous (Yes/No) response options.…”

Section: Methodsmentioning

confidence: 99%

General Practitioners’ Awareness and Perception of Current Pneumococcal Vaccination for Adult Patients with Known Risk Factors in Switzerland: Evidence from a Survey

2023

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In Switzerland, the National Immunization Advisory Group (NITAG) has formulated recommendations for pneumococcal vaccination among adult risk patients. Little is known about general practitioners’ (GPs’) perception, knowledge, and implementation of these recommendations. Therefore, we investigated GPs’ awareness and drivers of and barriers to pneumococcal vaccination using a cross-sectional web-based survey of GPs. Of the 300 study participants, 81.3% were aware of the recommendations for vaccinating at-risk adult patients, but only 42.7% were aware of all risk groups. The recommendations were perceived by 79.7% as slightly to very complex. Most GPs (66.7%) had good arguments to convince patients to get vaccinated, but only 41.7% reported recognizing patients at risk for pneumococcal disease, and only 46.7% checked their patients’ vaccination status and proposed vaccination if needed. The main reasons for not vaccinating were patients’ refusal (80.1%), lack of reimbursement by the health insurance (34.5%), patients’ fear of side effects (25.1%), and lack of regulatory approval despite the NITAG recommendations (23.7%). Most (77.3%) agreed that the treating chronic disease specialist should recommend the vaccination and 94.7% believed that adult-risk patients would not be aware of their need for pneumococcal vaccinations. Optimal implementation of the recommendations will require addressing knowledge gaps and reported barriers.

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“…Since the guidelines were published, further studies have provided more evidence on FIT’s utility in primary care, not only to rule out (most evidence) but also to rule in (least evidence) CRC [ 59 , 73 , 75 – 81 ]. While a recent survey of 1024 GPs in England found that less than half recognised DG30 [ 82 ], it is likely that awareness has increased recently owing to FIT availability, and the increasing use of FIT as a result of limited colonoscopy capacity exacerbated by the COVID-19 pandemic, including to triage patients referred on the urgent pathway [ 83 , 84 ]. While some guidance has been published on such use [ 85 ], evidence on its impact is still limited and it is unclear whether FIT will continue to be used as such (and to what extent) after the COVID-19 pandemic.…”

Section: Referral and Investigationsmentioning

confidence: 99%

Recognising Colorectal Cancer in Primary Care

et al. 2021

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Colorectal cancer (CRC) is the third most common cancer worldwide. Primary care professionals can play an important role in both prevention and early detection of CRC. Most CRCs are attributed to modifiable lifestyle factors, which can be addressed within primary care, and promotion of population-based screening programmes can aid early cancer detection in asymptomatic patients. Primary care professionals have a vital role in clinically assessing patients presenting with symptoms that may indicate cancer, as most patients with CRC first present with symptoms. These assessments are often challenging—many of the symptoms of CRC are non-specific and commonly occur in patients presenting with non-malignant disease. The range of options for investigating symptomatic patients in primary care is rapidly growing. Simple tests, such as faecal immunochemical testing (FIT), are now being used to guide decisions around referral for more invasive tests, such as colonoscopy, while direct access to specialist investigations is also becoming more common. Clinical decision support tools (CDSTs) which calculate cancer risk based on symptomatology, patient characteristics and test results can provide an additional resource to guide decisions on further investigation. This article explores the challenges of CRC prevention and detection from the primary care perspective, discusses current evidence-based approaches for CRC detection used in primary care (with examples from UK guidelines), and highlights emerging research which may likely alter practice in the future.

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General practitioners’ awareness of the recommendations for faecal immunochemical tests (FITs) for suspected lower gastrointestinal cancers: a national survey

Cited by 5 publications

References 21 publications

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

Faecal immunochemical testing for adults with symptoms of colorectal cancer attending English primary care: a retrospective cohort study of 14 487 consecutive test requests

General Practitioners’ Awareness and Perception of Current Pneumococcal Vaccination for Adult Patients with Known Risk Factors in Switzerland: Evidence from a Survey

Recognising Colorectal Cancer in Primary Care

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