Attitudes towards faecal immunochemical testing in patients at increased risk of colorectal cancer: an online survey of GPs in England

von Wagner, Christian, Stoffel, Sandro, Freeman, Madeleine, Laszlo, Helga, Nicholson, Brian D, Sheringham, Jessica, Szinay, Dorothy and Hirst, Yasemin (2018) Attitudes towards faecal immunochemical testing in patients at increased risk of colorectal cancer: an online survey of GPs in England. British Journal of General Practice, 68 (676). e757-e764. ISSN 0960-1643

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Background: There is increasing interest in using a quantitative faecal immunochemical test (FIT) to rule out colorectal cancer (CRC) in patients with high-risk symptoms in primary care.  Aim: This study aimed to investigate GPs’ attitudes and willingness to use a FIT over an urgent 2-week wait (2WW) referral.  Design and setting: A cross-sectional online survey involving 1024 GPs working across England.  Method: Logistic regression models were used to explore the likelihood of GPs using a FIT instead of a 2WW referral, and reported using odds ratios (ORs) and 95% confidence intervals (95% CIs).  Results: Just over one-third of GPs (n = 365) preferred to use a FIT as a rule-out test over a 2WW referral. GPs were more willing if they were: aged 36–45 years (OR 1.59 [95% CI = 1.04 to 2.44]); 46–55 years (OR 1.99 [95% CI = 1.14 to 3.47]); thought a FIT was highly accurate (OR 1.63 [95% CI = 1.16 to 2.29]); thought patients would benefit compared with having a colonoscopy (OR 2.02 [95% CI = 1.46 to 2.79]); and were highly confident about discussing the benefits of a FIT (OR 2.14 [95% CI = 1.46 to 3.16]). GPs were less willing if they had had >10 urgent referrals in the past year (OR 0.62 [95% CI = 0.40 to 0.94]) and thought that longer consultations would be needed (OR 0.61 [95% CI = 0.44 to 0.83]).  Conclusion: The study findings suggest that the acceptability of using a FIT as a rule-out test in primary care is currently low, with less than half of GPs who perceived the test to be accurate preferring it over colonoscopy. Any potential guideline changes recommending a FIT in patients with high-risk symptoms, instead of urgent referral to rule out CRC, are likely to require intensive supporting educational outreach to increase GP confidence in the accuracy and application of a FIT in this context.

Item Type: Article
Uncontrolled Keywords: colorectal cancer,cross-sectional survey,primary care,2-week wait,symptomatic,faecal immunochemical test
Depositing User: LivePure Connector
Date Deposited: 07 Nov 2018 12:30
Last Modified: 22 Jul 2020 02:39
DOI: 10.3399/bjgp18X699413

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