In July 2017, the National Institute for Health and Care Excellence (NICE) updated the cancer referral guideline to include a recommendation for faecal immunochemical test (FIT) as a primary care triage test for patients with ‘low risk but no risk’ of colorectal cancer (CRC). There has also been interest in using a FIT as a rule-out test for patients with high-risk symptoms.
The results of a new online survey published in the British Journal of General Practice suggest there are barriers that must be overcome if FIT is to become a standard practice over the 2-week wait (2WW) referral pathway.
Of 1024 general practitioners (GPs) who participated in the survey, 42.2% were aware of the use of FIT as a rule-in test for patients with low-risk symptoms, but only 23.0% were aware that it could also be used as a rule-out test.
Just above one-third preferred FIT over a 2WW referral as a rule-out test. GPs showed greater preference for FIT if they were: aged 36-45 years (OR, 1.59) or 46-55 years (OR, 1.99); thought FIT was highly accurate (OR, 1.63); thought patients would benefit more from FIT vs colonoscopy (OR, 2.02); and were confident about discussing the benefits of FIT (OR, 2.14). GPs were less willing if they had more than 10 urgent referrals in the past year (OR, 0.62) and thought that longer consultations would be needed (OR, 0.61).
The authors say the findings suggest that the acceptability of using FIT as a rule-out test in primary care is currently low and any potential guideline changes recommending FIT in patients with high-risk symptoms will likely require intensive education to increase GP confidence in the accuracy and application of the test in this context.
