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Patients' Difficulties with Five Different Fecal Immunochemical Tests.

Jeanette M Daly¹, Yinghui Xu², Barcey T Levy²

¹From the Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA (JD, YX, BTL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (BTL); Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA (BTL). jeanette-daly@uiowa.edu.

Journal of the American Board of Family Medicine : JABFM

|March 21, 2025

Summary

Patients strongly prefer liquid vial fecal immunochemical tests (FITs) over card-based ones. Difficulty in FIT collection is linked to errors and specific brands, highlighting the need for clear instructions.

Keywords:

Cancer Screening Colorectal Cancer Fecal Immunochemical Tests Fecal Occult Blood Test Surveys and Questionnaires

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Area of Science:

Gastroenterology
Clinical Diagnostics
Patient Experience Research

Background:

Numerous fecal immunochemical tests (FITs) are available in the US, with both liquid vial and card collection devices.
Understanding user preferences and collection challenges is crucial for optimizing FIT utilization.

Purpose of the Study:

To evaluate participant difficulties and preferences regarding different FIT collection devices.
To determine if FIT collection errors correlate with perceived collection difficulty.
To identify factors contributing to difficulties encountered during FIT stool sample collection.

Main Methods:

A prospective study involved 2,148 individuals scheduled for colonoscopy, comparing the characteristics of 5 different FITs.
Participants completed a product questionnaire assessing ease of use and any difficulties encountered during FIT collection.

Main Results:

A significant majority (61%) preferred liquid vial FITs over card-based devices (9%).
Liquid vials generally had higher rates of perceived ease of collection (66-70% no difficulty) compared to Hemoccult ICT (49% no difficulty).
Difficulties included messiness and small collection windows for cards, while liquid vials presented challenges with probing/scraping stool and unclear instructions; perceived difficulty was higher for Hemoccult ICT and associated with FIT errors.

Conclusions:

Liquid vial FITs are strongly preferred by patients over card-based formats.
Perceived difficulty in FIT collection is a significant predictor of FIT errors and varies by FIT brand.
Healthcare providers should prioritize clear patient education on FIT collection to minimize errors.