“Finding the Right FIT”: Rural Patient Preferences for Fecal Immunochemical Test (FIT) Characteristics

Abstract

Purpose: Colorectal cancer (CRC) is the third leading cause of cancer death in the UnitedStates, yet 1 in 3 Americans have never been screened for CRC. Annual screening using fecal immunochemical tests (FITs) is often a preferred modality in populations experiencing CRC screening disparities. Although multiple studies evaluate the clinical effectiveness of FITs, few studies assess patient preferences toward kit characteristics. We conducted this community-led study to assess patient preferences for FIT characteristics and to use study findings in concert with clinical effectiveness data to inform regional FIT selection.Methods: We collaborated with local health system leaders to identify FITs and recruit age eligible (50 to 75 years), English or Spanish speaking community members. Participants completed up to 6 FITs and associated questionnaires and were invited to participate in a follow-up focus group. We used a sequential explanatory mixed-methods design to assess participant preferences and rank FIT kits. First, we used quantitative data from user testing to measure acceptability, ease of completion, and specimen adequacy through a descriptive analysis of 1) fixed response questionnaire items on participant attitudes toward and experiences with FIT kits, and 2) a clinical assessment of adherence to directions regarding collection, packaging, and return of specimens. Second, we analyzed qualitative data from focus groups to refine FIT rankings and gain deeper insight into the pros and cons associated with each tested kit.Findings: Seventy-six FITs were completed by 18 participants (Range, 3 to 6 kits per participant). Over half (56%, n ‫؍‬ 10) of the participants were Hispanic and 50% were female (n ‫؍‬ 9). Thirteen participants attended 1 of 3 focus groups. Participants preferred FITs that were single sample, used a probe and vial for sample collection, and had simple, large-font instructions with colorful pictures. Participants reported challenges using paper to catch samples, had difficulty labeling tests, and emphasized the importance of having care team members provide verbal instructions on test completion and follow-up support for patients with abnormal results. FIT rankings from most to least preferred were OCLight, Hemosure iFOB Test, InSure FIT, QuickVue, OneStep؉, and Hemoccult ICT.

Eliciting vulnerable patients’ preferences regarding colorectal cancer screening: a systematic review

“…Two studies focused primarily on US rural populations’ preferences for CRC screening ( Table 5 ). 83 , 84 Pham et al studied a rural population that consisted of predominantly Hispanics, but a subgroup analysis to see whether preference varied by race was not conducted. 83 This study assessed delivery attributes of different fecal test options and found that participants prefer tests that use probes and vials, require a single stool sample, and provide clear, visual instructions.…”

A systematic review of clinic and community intervention to increase fecal testing for colorectal cancer in rural and low-income populations in the United States – How, what and when?

“…We are seeing a shift to address these needs through funding opportunities through the Cancer Moonshot, in NCI and CDC’s continued support of collaborative research networks and implementation research, as well as the emergence of local initiatives in response to advanced payment models that reward improved CRC screening and disparities reduction [ 74 , 75 ]. Taking the next step forward in implementation of evidence-based approaches to improve cancer screening also argues for investing in academic-community collaborations before research studies begin through the infrastructure of practice-based research networks [ 76 ], researcher in residence models [ 77 ], or participatory research methods [ 78 , 79 ]. Such partnered approaches can help actualize the call for rapid and relevant science [ 80 ].…”

Follow‐up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial

“…Unlike other cancer screening, CRC screening Cancer October 15, 2019 has a literacy burden in that patients must understand and accurately follow instructions for FIT completion or colonoscopy preparation. Although FIT is more convenient, cost-effective, and preferred by many low-income patients, 43 it has multiple steps that must be followed correctly. In the current study simplified instructions accompanied by a face-to-face demonstration of FIT and use of the "teach-back" method to confirm understanding with a follow-up telephone call if needed clearly addressed literacy barriers and facilitated completion rates of all patients, particularly those with limited literacy.…”