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

Christian von Wagner (Lead Author), Sandro Stoffel, Madeleine Freeman, Helga Laszlo, Brian D Nicholson, Jessica Sheringham, Dorothy Szinay, Yasemin Hirst

Research output: Contribution to journalArticle

9 Citations (Scopus)
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Abstract

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.
Original languageEnglish
Pages (from-to)e757-e764
JournalBritish Journal of General Practice
Volume68
Issue number676
Early online date25 Oct 2018
DOIs
Publication statusPublished - Nov 2018
Externally publishedYes

Keywords

  • colorectal cancer
  • cross-sectional survey
  • primary care
  • 2-week wait
  • Symptomatic
  • faecal immunochemical test

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