Programme no. 558-P
Use of immunochemical faecal occult blood tests in general practice: a study of patients presenting un-characteristic symptoms of colorectal cancer in primary care
Jakob Søgaard Juul*1, Nete Hornung2, Berit Sanne Andersen3, Søren Laurberg4, Frede Olesen5, Peter Vedsted6
1Research Unit for General Practice,Aarhus University,Aarhus,Denmark, 2Department of Clinical Biochemistry,Regional Hospital of Randers,Randers,Denmark, 3Department of Public Health Programs,Regional Hospital of Randers,Randers,Denmark, 4Department of Surgery,Aarhus University Hospital,Aarhus,Denmark, 5Research Unit for General Practice,Aarhus University,Aarhus,Denmark, 6Research Unit for General Practice,Aarhus University,Aarhus,Denmark
* = Presenting author
Objectives: To develop a guideline for the use of iFOBT in general practice and assess the implementation of this guideline in combination with iFOBT in general practice.
Background: Colorectal cancer (CRC) is a common malignancy and a leading cause of cancer-related death. Clinical assessment of patients suspected of CRC is challenged by poor predictors of illness as many patients initially present with uncharacteristic or vague symptoms. However, research shows that many patients diagnosed with CRC consult their general practitioner (GP) more often than usual for several months before the diagnosis. The immunochemical faecal occult blood test (iFOBT), which is used for screening in many countries, can test for occult blood in the stool and may serve as an important tool for the GP in the evaluation of patients presenting with uncharacteristic symptoms of CRC.
Results: Primary outcomes: indications of iFOBT, frequency of iFOBT use, and actions taken on test result.
Secondary outcomes: colonoscopy findings, number of performed colonoscopies, and cancer stage at diagnosis.
Material/Methods: A guideline on iFOBT use in general practice will be developed from existing literature. The guideline will be aimed at men and women aged ≥30 years who present symptoms of CRC, but who do not fulfill the criteria for the urgent referral pathway. The guideline will contain a list of symptoms for which iFOBT performance is recommended and will include suggested actions for positive and negative test results. Cut-off values for determination of positive and negative test results will be set at 50 ng haemoglobin/ml faeces. The guideline will be made available together with iFOBT for general practices in the Central Denmark Region at the start of the study period. Practices will be randomised into four groups; each will receive an intervention package consisting of a lecture on CRC symptoms, iFOBT equipment and guideline. The intervention package will be implemented with a stepped-wedge design during the first six months according to randomisation.
Conclusion: This study will provide important knowledge both nationally and internationally on the use of iFOBT in general practice when patients present with uncharacteristic symptoms of CRC. These findings may provide better diagnostic tools for CRC and thereby improve patient outcome in the future.
Points for discussion: Advantages and disadvantages of implementing iFOBT in general practice