A program that provided additional outreach and low-literacy instructions helped improve patient handling of fecal immunochemical test samples, according to research published in Clinical Gastroenterology and Hepatology.
Ma Somsouk, MD, MAS, of the division of gastroenterology at the University of California San Francisco, and colleagues wrote that the characteristics of FIT could change depending on how the samples are handled. Additionally, patients who receive care from “safety-net” systems might experience difficultly understanding written, English instructions for FIT.
“Despite effectiveness of FIT for population-level screening for [colorectal cancer], screening relies on patients properly completing FIT tests for laboratory processing,” they wrote. “As clinical laboratory practices vary, and some labs discard mishandled FIT samples, properly completing FIT for lab processing is an important first step in stool-based screening.”
For a prospective study, researchers recruited patients who were not up to date with their CRC screening and randomly assigned them to receive usual care FIT (n = 1,871) or test kits with low-literacy level instructions, a reminder call or both (n = 3,045). They explored the data to find the most common reasons for mishandled samples, the frequency of mishandled samples and effects of outreach.
The data showed that 19.8% of the samples were mishandled. The most common issue was not labeling the samples with the date of collection (93.7%). Just 1.2% of samples were not tested because the time from patient to lab was more than 14 days.
Investigators found that outreach was associated with lower proportion of mishandled samples compared with usual care (16.5% vs. 25%; P < .0001), and patients who received low-literacy instructions and a reminder call had the lowest rates of mishandling (12.8%;
P < .001).
Despite the differences in mishandling, researchers found no significant difference in the proportion of positive results between properly processed samples and improperly processed samples.
“This study underscores the value of low literacy instructions and timely use of prompts and reminders to educate and engage patients in testing,” Samsouk and colleagues wrote. “Pictorial-based instructions increase FIT test completion and return rate; in the same way, we show that low literacy wordless FIT instruction was associated with a reduction in mishandled samples.” – by Alex Young
Disclosures: The authors report no relevant financial disclosures.