Patients' Difficulties with Five Different Fecal Immunochemical Tests

Abstract

Background: At least 26 different fecal immunochemical tests (FITs) are available for use in the US. Liquid vial and card collection devices are available. Objectives: 1) assess participant’s difficulties with and preferences for types of FITs; 2) assess whether errors in FIT collection were associated with FIT collection difficulty; 3) identify factors associated with difficulty with FIT stool collection. Methods: Prospective individuals scheduled for a colonoscopy were invited to participate in a study comparing test characteristics of 5 FITs. A product questionnaire asked participants about ease of collection and difficulties. Results: 2,148 participants; mean age 63 years; 63% females, 83% Whites, and 19% Hispanics. 1265 (61%) preferred use of a liquid vial versus 181 (9%) the card. 49% had no difficulty with Hemoccult ICT, and 66 to 70% had no difficulty with the liquid vials. Difficulties with Hemoccult ICT included: being messy (21%), collection window too small (19%), and getting sample on stick (8%). Difficulties with the liquid vials included difficulty probing or scraping the stool (5% to 8%) and unclear directions (3%). In a multivariable model, the perceived difficulty in FIT collection was significantly higher for Hemoccult ICT compared with OC-Auto Micro (adjusted odds ratio [AOR], 4.05), and it was significantly high for those with a FIT error (AOR, 3.90). Conclusion: Participants strongly preferred a liquid vial compared with a card. Perceived difficulty was significantly associated with FIT errors and with FIT brand. Medical offices providing FITs should ensure that patients understand the task of FIT collection, so that errors are minimized.