O42 Current barriers to patients proceeding with diagnostic tests in the English bowel cancer screening programme

Abstract

<h3>Introduction</h3> Uptake rates and pathology detection has increased significantly with integration of faecal immunochemical testing (FIT) in the English Bowel Cancer Screening Programme (BCSP). However a proportion of patients do not uptake diagnostic tests after positive FIT tests. We compared pre and peri-COVID cohorts to identify current barriers to uptake of diagnostic tests within a single, large BCSP centre. <h3>Methods</h3> Two patient cohorts were analysed from the Wolverhampton BCSP Centre (September 2019-February 2020 (Group A, pre-Covid) and April-July 2021 (Group B, peri-Covid)). Patients with a positive FIT were assessed by either a face-to-face (F2F) consultation (Group A) or a telephone consultation (TC) (Group B) by a specialist screening practitioner (SSP) and offered information and diagnostic tests. Total overall numbers were recorded and cases not proceeding with diagnostic tests reviewed. Statistical analysis utilised Fisher’s exact test where appropriate. <h3>Results</h3> In group A, 26293/42545 (61.8%) patients returned a FIT test compared with, 30214/45538 (66.3%) in group B (p&lt;0.00001) with similar positivity rates (2.1% (A) vs. 2.2% (B), p=NS). The peri-COVID era shows an increase in patients not proceeding with diagnostic tests after positive FIT tests (Group A 90/633 (14.2%) Vs. Group B 144/655 (22%), p=0.0003). Table 1 expands the reasons for this. <h3>Conclusion</h3> FIT sample return rates have increased in the peri-COVID era but proportions of patients not proceeding with diagnostic investigations following positive FIT testing have risen. Patient choice is a notable barrier to uptake and other barriers which have significantly increased during this current period are patients being assessed as clinically unsuitable due to health reasons, declining initial telephone appointments and DNA tests. Whilst informed patient choice is key in national screening programmes, cancer and polyp detection in FIT positive patients in BCSP are notable. Understanding patient’s perspectives on tests, preferences over TC or F2F and SSP education on health assessment for colonoscopy may improve uptake of diagnostic tests within the BCSP.