VIDEO: One in 10 FIT ‘unsatisfactory’ in screening for CRC, mainly due to patient error
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In this Healio video, Rasmi Nair, MBBS, MPH, PhD, reports findings from a recent study, which showed 10% of at-home fecal immunological tests for colorectal cancer screening could not be processed, mostly due to specimen errors.
“We hope to learn more about where the blame lies,” Nair, assistant professor in the Peter O’Donnell Jr. School of Public Health at UT Southwestern Medical Center in Dallas, told Healio. “Is it more patient-related? Did the patient not understand the instructions with regards to FIT or was it more system- or provider-related? Although our research is great at identifying the issue, we still are not able to pinpoint the exact problem.”
In a retrospective cohort study, Nair and colleagues investigated the prevalence of and reasons for unsatisfactory FIT by examining at-home tests submitted between 2010 and 2019 by 56,980 individuals, aged 50 to 74 years and of average risk for CRC, at Parkland Health, a safety-net health system in Dallas. Researchers also assessed subsequent testing within 15 months following an unsatisfactory FIT.
According to Nair, at least one in 10 individuals had an unsatisfactory FIT, which she noted is double the 5% recommended threshold established by the U.S. Multi-Society Task Force on Colorectal Cancer.
“The majority of FIT were unsatisfactory because the stool sample was not collected appropriately,” she said, adding that improper transportation or late processing were among other reasons for failed tests.
Notably, only 43% of those with an unsatisfactory FIT had a follow-up test, Nair said.
“We identified this big gap where we have these underinsured or uninsured patients, got them screened, then the results could not be [used] and we did not follow-up with another FIT.”
According to Nair, patients and physicians alike would benefit from the implementation of an automated system that sends notification of an unsatisfactory FIT and orders a follow-up test. This could also help identify patients who may not understand test instructions or who are not collecting samples correctly, providing an opportunity for additional education.
“There should be more quality improvement projects that are aimed to make sure if there is an unsatisfactory FIT, the patient is notified by an administrative system that orders another FIT,” Nair said. “When that FIT is ordered, someone can call up the patient to make sure the patient understands that another FIT needs to be done in a certain way [and] needs to be returned within a certain period of time, so that the next the FIT is not unsatisfactory.”
References:
- At-home colorectal cancer screenings pose challenges for some. https://www.utsouthwestern.edu/newsroom/articles/year-2023/dec-at-home-colorectal-cancer-screenings.html. Published Dec. 14, 2023. Accessed Feb. 19, 2024.
- Liu P, et al. Cancer Epidemiol Biomarkers Prev. 2024;doi.org/10.1158/1055-9965.EPI-23-0507.
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