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 M Snudden; Natalia Calanzani; Stephanie Archer; Stephanie Honey; Merel M Pannebakker; Anissa Faher; Aina Chang; Willie Hamilton; Fiona M Walter

doi:10.1136/bmjopen-2023-072359

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

BMJ Open. 2023 Jun 14;13(6):e072359. doi: 10.1136/bmjopen-2023-072359.

Authors

Claudia M Snudden¹, Natalia Calanzani^{2

3}, Stephanie Archer², Stephanie Honey⁴, Merel M Pannebakker², Anissa Faher⁵, Aina Chang⁵, Willie Hamilton⁶, Fiona M Walter^{2

7}

Affiliations

¹ Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK cs2048@medschl.cam.ac.uk.
² Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
³ Academic Primary Care, University of Aberdeen Institute of Applied Health Sciences, Aberdeen, UK.
⁴ Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
⁵ School of Clinical Medicine, University of Cambridge, Cambridge, UK.
⁶ University of Exeter Medical School, University of Exeter, Exeter, UK.
⁷ Wolfson Institute of Population Health, Queen Mary University of London, London, UK.

Abstract

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.

Keywords: gastroenterology; primary care; qualitative research.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Colorectal Neoplasms* / diagnosis
England
Female
Humans
Male
Middle Aged
Patient Outcome Assessment*
Primary Health Care
Qualitative Research

Abstract

Publication types

MeSH terms

Grants and funding