The Article in Brief

Reasons Patients With a Positive Fecal Occult Blood Test Result Do Not Undergo Complete Diagnostic Evaluation

Masahito Jimbo , and colleagues

Background The fecal occult blood test (FOBT) is an effective method of screening patients for colorectal cancer. To be effective at preventing colon cancer, positive FOBT tests must be followed up with further testing, such as colonoscopy. However, in practice, follow-up of positive FOBT results does not always occur. This study examines reasons for this low rate of complete diagnostic evaluation following a positive FOBT.

What This Study Found For a majority of patients, primary care doctors' reported reasons for not performing a complete diagnostic evaluation are appropriate. A common reason for not performing a complete diagnostic evaluation is that one had been completed within 3 years before the FOBT-positive result. Further analysis, however, shows that a significant proportion of decisions not to perform a complete evaluation are not compatible with established guidelines.

Implications

• Because decision making by primary care doctors appears to have a major effect on whether a complete diagnostic evaluation is performed after a positive FOBT result, colorectal screening programs should include guidance for doctors on this issue.
• These findings will shed light on potential strategies to help doctors improve rates of complete diagnostic evaluation in FOBT-positive patients.