Research Department of Behavioural Science and Health.
UCLH Cancer Collaborative, London.
Br J Gen Pract. 2018 Nov;68(676):e757-e764. doi: 10.3399/bjgp18X699413. Epub 2018 Oct 8.
There is increasing interest in using a quantitative faecal immunochemical test (FIT) to rule out colorectal cancer (CRC) in patients with high-risk symptoms in primary care.
This study aimed to investigate GPs' attitudes and willingness to use a FIT over an urgent 2-week wait (2WW) referral.
A cross-sectional online survey involving 1024 GPs working across England.
Logistic regression models were used to explore the likelihood of GPs using a FIT instead of a 2WW referral, and reported using odds ratios (ORs) and 95% confidence intervals (95% CIs).
Just over one-third of GPs ( = 365) preferred to use a FIT as a rule-out test over a 2WW referral. GPs were more willing if they were: aged 36-45 years (OR 1.59 [95% CI = 1.04 to 2.44]); 46-55 years (OR 1.99 [95% CI = 1.14 to 3.47]); thought a FIT was highly accurate (OR 1.63 [95% CI = 1.16 to 2.29]); thought patients would benefit compared with having a colonoscopy (OR 2.02 [95% CI = 1.46 to 2.79]); and were highly confident about discussing the benefits of a FIT (OR 2.14 [95% CI = 1.46 to 3.16]). GPs were less willing if they had had >10 urgent referrals in the past year (OR 0.62 [95% CI = 0.40 to 0.94]) and thought that longer consultations would be needed (OR 0.61 [95% CI = 0.44 to 0.83]).
The study findings suggest that the acceptability of using a FIT as a rule-out test in primary care is currently low, with less than half of GPs who perceived the test to be accurate preferring it over colonoscopy. Any potential guideline changes recommending a FIT in patients with high-risk symptoms, instead of urgent referral to rule out CRC, are likely to require intensive supporting educational outreach to increase GP confidence in the accuracy and application of a FIT in this context.
越来越多的人对使用定量粪便免疫化学测试（FIT）来排除初级保健中高危症状患者的结直肠癌（CRC）感兴趣。
本研究旨在调查全科医生对在两周内（2WW）紧急转介中使用 FIT 的态度和意愿。
这是一项涉及英格兰各地 1024 名全科医生的横断面在线调查。
使用逻辑回归模型来探讨全科医生使用 FIT 而不是 2WW 转介的可能性，并报告使用的优势比（OR）和 95％置信区间（95％CI）。
略多于三分之一的全科医生（n=365）更愿意将 FIT 用作排除测试，而不是 2WW 转介。如果他们：年龄在 36-45 岁（OR 1.59 [95％CI = 1.04 至 2.44]）；46-55 岁（OR 1.99 [95％CI = 1.14 至 3.47]）；认为 FIT 高度准确（OR 1.63 [95％CI = 1.16 至 2.29]）；认为与结肠镜检查相比，患者将受益（OR 2.02 [95％CI = 1.46 至 2.79]）；并且对讨论 FIT 的益处非常有信心（OR 2.14 [95％CI = 1.46 至 3.16]）。如果过去一年中他们有超过 10 个紧急转介（OR 0.62 [95％CI = 0.40 至 0.94]），并且认为需要更长的咨询时间（OR 0.61 [95％CI = 0.44 至 0.83]），则不太愿意使用 FIT。
研究结果表明，目前在初级保健中使用 FIT 作为排除测试的可接受性较低，只有不到一半的认为该测试准确的全科医生更喜欢使用 FIT 而不是结肠镜检查。任何可能推荐在高危症状患者中使用 FIT 而不是紧急转介以排除 CRC 的指南变化，都可能需要密集的支持性教育外出来增加全科医生对 FIT 在这种情况下的准确性和应用的信心。
