Abstract
BackgroundThere 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.AimThis study aimed to investigate GPs’ attitudes and willingness to use a FIT over an urgent 2-week wait (2WW) referral.Design and settingA cross-sectional online survey involving 1024 GPs working across England.MethodLogistic 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).ResultsJust 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]).ConclusionThe 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.
Highlights
Colorectal cancer (CRC) is the third most common cancer in the UK and the second biggest cancer killer.[1]
The study findings suggest that the acceptability of using a faecal immunochemical test (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 colorectal cancer (CRC), are likely to require intensive supporting educational outreach to increase GP confidence in the accuracy and application of a FIT in this context
Summary
Colorectal cancer (CRC) is the third most common cancer in the UK and the second biggest cancer killer.[1]. For patients who can tolerate the procedure, colonoscopy is the current gold-standard test to rule out and detect CRC; it is accessed via the fast-tracked 2-week wait (2WW) pathway; that is, the maximum wait-time target in the UK for patients with suspected cancer to be first seen by a specialist in secondary care.[7,8] Notwithstanding the potential human cost of an invasive procedure, colonoscopy could miss up to 10% of cancers and carries a small risk of complications.[9] In addition, currently, colonoscopy resources in the UK are stretched to their limits.[10,11,12] The Achieving World-Class Cancer Outcomes cancer strategy 2015–2020 advocates increased access for GPs to diagnostic point-of-care tests in primary care;[13] only about half of patients with CRC receive a test in primary care before an urgent referral for suspected CRC.[14]. 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
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