Patient attitudes towards faecal immunochemical testing for haemoglobin as an alternative to colonoscopic surveillance of groups at increased risk of colorectal cancer

Abstract

Objectives: To examine attitudes towards an annual faecal immunochemical test for haemoglobin (FIT) versus three-yearly colonoscopic surveillance of individuals at intermediate risk of colorectal cancer (CRC). Setting: A London hospital. Methods: Five semi-structured discussion groups were conducted with 28 adults (aged 60-74, 61% female) with different levels of CRC risk and experience of colonoscopy or colonoscopic surveillance. Information was presented sequentially using a step-by-step discussion guide. Results were analyzed using thematic analysis. Results: When evaluating FIT in the context of a surveillance programme, all respondents readily made comparisons with related tests that they had been exposed to previously. Those with no experience of surveillance were enthusiastic about an annual FIT to replace three-yearly colonoscopy, because they felt that the higher testing frequency could improve detection of advanced lesions. Those with experience of colonoscopic surveillance did not perceive FIT to be as accurate as colonoscopy, and therefore either preferred colonoscopy on its own or wanted an annual FIT in addition to three-yearly colonoscopy. Conclusions: FIT may be well-received as an additional method of surveillance for new patients at intermediate risk of CRC. More research is required to better understand potential barriers associated with FIT surveillance for patients with experience of colonoscopic surveillance.

Public preferences for using quantitative faecal immunochemical test versus colonoscopy as diagnostic test for colorectal cancer: evidence from an online survey

“…27 Similarly, it was not surprising that responders with higher perceived CRC risk were more likely to switch sooner to CC given previous evidence showing that high-risk patients are more likely to prefer CC compared with FIT. 24 In contrast, the finding that responders with low numeracy switched sooner to CC was novel and requires further investigation.…”

“…23 There are also strong parallels with studies looking at preferences for CC versus FIT in the symptomatic context. 24,25 Furthermore, there is the observation that women had a higher tolerance for missed cancers before switching to CC. This finding was in line with previous research demonstrating that women report more pain during CC 26 and have a stronger preference for non-invasive CRC diagnostic modalities.…”

Faecal immunochemical tests versus colonoscopy for post-polypectomy surveillance: an accuracy, acceptability and economic study

“…A discussion group was convened in November 2011 to discuss the practicalities of using FIT, the implications of the results and the possible risks associated with FIT. As a result of users' feedback about the psychological implications of receiving a false-positive test result, patient materials were modified to clearly demonstrate the possibility of testing false positive (see Chapter 4 and Bowyer et al 67 for full details and results).…”

“…Our criteria were based on previous research, which suggested that participants would consider any form of CRC-related abnormality a significant clinical finding. 67,88 These categories excluded people who did not complete their end-of-study questionnaire and participants who had CRC detected by whatever means. As a result, our definition of an abnormal result was different from the one used to categorise clinical findings in the main study.…”

“…FIT is administered at home, is non-invasive and requires only a single stool sample, thereby significantly reducing the unpleasantness associated with other home-based stool tests. 67 As such, FIT is aligned with people's preferences for CRC tests that are non-invasive, avoid pain as much as possible and do not require bowel preparation, while offering high levels of sensitivity and specificity. 78 One study found that average-risk participants who were concerned about procedural discomfort were more likely to choose FIT over colonoscopy as a screening modality.…”