Practitioner perspectives on symptomatic faecal immunochemical testing in the UK: a qualitative interview study.

Abstract

Faecal immunochemical testing (FIT) is now core to the management of patients presenting in primary care with symptoms of possible colorectal cancer. Patients with a positive FIT (≥10 μg haemoglobin [Hb]/g faeces) qualify for an urgent suspected cancer referral. FIT-negative patients are typically managed in primary care or referred through routine pathways. To examine practitioners' experiences of delivering symptomatic FIT, identifying perceived benefits, disbenefits, and implementation issues, to inform potential future service improvements. A qualitative interview study with primary and secondary care health professionals involved in delivering symptomatic FIT pathways from across the UK. Thirty semi-structured interviews were conducted with professionals from a range of specialties. An iterative topic guide informed interviews while allowing freedom to explore novel lines of enquiry. Pseudo-anonymised transcripts were coded, and themes were identified and developed. Symptomatic FIT was seen to be beneficial for increasing confidence in clinical decision making and enriching the pool of patients being definitively investigated for colorectal neoplasia. There were varying views on the impact of symptomatic FIT on workload with the burden of additional workload generally seen to impact primary care. Concerns about current practice included overuse of FIT, burden of investigations in patients with false-positive results, and diagnostic delays for both cancer and benign disease. Uncertainties existed around management of patients with rectal bleeding, appropriate strategies for safety netting, and the value of repeat FIT. Symptomatic FIT is largely seen as beneficial; however, health professionals would welcome further evidence and guidance around optimal application.