Can we do better? A qualitative study in the East of England investigating patient experience and acceptability of using the faecal immunochemical test in primary care

Claudia Snudden* (Corresponding Author), Natalia Calanzani, Stephanie Archer, Stephanie Honey, Merel M. Pannebakker, Anissa Faher, Aina Chang, Willie Hamilton, Fiona Walter

*Corresponding author for this work

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Objectives The faecal immunochemical test (FIT) is increasingly used in UK primary care to triage patients presenting with symptoms and at different levels of colorectal cancer risk. Evidence is scarce on patients’ views of using FIT in this context. We aimed to explore patients’ care experience and acceptability of using FIT in primary care.

Design A qualitative semi-structured interview study. Interviews were conducted via Zoom between April and October 2020. Transcribed recordings were analysed using framework analysis.

Setting East of England general practices.

Participants Consenting patients (aged ≥40 years) who presented in primary care with possible symptoms of colorectal cancer, and for whom a FIT was requested, were recruited to the FIT-East study. Participants were purposively sampled for this qualitative substudy based on age, gender and FIT result.

Results 44 participants were interviewed with a mean age 61 years, and 25 (57%) being men: 8 (18%) received a positive FIT result. Three themes and seven subthemes were identified. Participants’ familiarity with similar tests and perceived risk of cancer influenced test experience and acceptability. All participants were happy to do the FIT themselves and to recommend it to others. Most participants reported that the test was straightforward, although some considered it may be a challenge to others. However, test explanation by healthcare professionals was often limited. Furthermore, while some participants received their results quickly, many did not receive them at all with the common assumption that ‘no news is good news’. For those with a negative result and persisting symptoms, there was uncertainty about any next steps.

Conclusions While FIT is acceptable to patients, elements of communication with patients by the healthcare system show potential for improvement. We suggest possible ways to improve the FIT experience, particularly regarding communication about the test and its results.
Original languageEnglish
Article numbere072359
Number of pages9
JournalBMJ Open
Issue number6
Early online date14 Jun 2023
Publication statusPublished - 14 Jun 2023

Bibliographical note

Funding This work was supported by the CanTest Collaborative, which is funded by Cancer Research UK grant number C8640/A23385, of which FMW and WH are co-Directors, and NC, MMP and SH are postdoctoral researchers. This work was co-funded by the National Institute for Health Research (NIHR) Policy Research Programme, conducted through the Policy Research Unit in Cancer Awareness, Screening and Early Diagnosis, PR-PRU-1217-21601. CMS is an academic clinical fellow funded by the NIHR. The views expressed in this publication are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. The funding sources had no role in the study design, data collection, data analysis, data interpretation, writing of the report or in the decision to submit for publication.
We thank all the patients who agreed to be interviewed. We thank the North East Essex and Suffolk Pathology Services at the East Suffolk and North Essex NHS Foundation Trust, and the Clinical Biochemistry section of Laboratory Medicine at Norfolk and Norwich University Hospitals NHS Foundation Trust. They have added a study recruitment letter, consent form and prepaid envelope to each FIT kit, distributed these to GP practices and provided data on FIT results. We thank Professor Niek de Wit and Dr Peter Holloway for their support in the earlier stages of the study. We are grateful to Marije van Melle for her work in the early stages of study design. We thank James Brimicombe for data management advice, support and expertise, and Andy Cowan for his help collecting and managing FIT-East study data. We are grateful to the CanTest Patient & Public Involvement (PPI) Panel (special thanks to Margaret Johnson) for reading and commenting on interview transcripts.


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