Patients’ Preferences and Difficulties with 5 Different Fecal Immunochemical Tests (FITs)

Context: FITs are an accepted method of colorectal cancer (CRC) screening and patients’ preferences and difficulties are unknown. FITs would save nearly as many lives as colonoscopy with far fewer complications. Multiple FITs are available in the U.S.

Objectives: 1) assess participant’s preferences and difficulties with different FITs; 2) assess whether FIT collection errors were associated with collection difficulty, 3) identify factors associated with difficulty using FIT.

Study Design/Analysis: Prospective; participants completed 5 unique FITs according to those most commonly used. Standard descriptive statistics, chi-square or Fisher’s exact tests, and generalized linear mixed modeling were used.

Setting: 3 academic medical centers.

Population Studied: 2148 individuals aged 50 to 85 years scheduled for screening or surveillance colonoscopy.

Outcome/Instruments: Some difficulty vs. no difficulty with FIT collection for each of 5 unique FITs. Investigator-developed questionnaires and report form for FIT errors.

Results: Mean age was 63 years; 63% women, 83% Whites, and 19% Hispanics. 49% had no difficulty with Hemoccult ICT (card) and at least 66% stated they had no difficulty with the liquid vial tests.

Preferences for the general type of FITs were: 61% liquid vial, 30% no preference, and 9% card.

Difficulties included getting the sample in the correct window (card); removing the correct cap, having liquid spill from the vial, or feeling it was messy to collect the sample. Collection errors were noted for 3.2% Hemoccult ICT, 2.5% Hemosure iFOB, 0.4% OC-Light S, and 2.6% QuickVue iFOB. For OC-Auto, all samples were run assuming no errors. In the multivariable model, some difficulty in FIT collection was statistically significantly lower for those aged younger than 65 years compared to those 65-75 years (adjusted odds ratio [AOR], 0.65), those with high school education compared with college or higher (AOR, 0.68), and those having a household income less than $40,000 compared with income of $80,000 or more (AOR, 0.60). Individuals with errors in collection perceived statistically significantly more difficulty with collection.

Conclusion: Most participants preferred a liquid vial compared to a card. FIT manufacturers should develop very clear directions for patients. Individuals who had errors perceived more difficulty with collection. Contrary to expected, individuals with lower incomes and less education perceived less difficulty with collection.