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General practitioners’ awareness of the recommendations for faecal immunochemical tests (FITs) for suspected lower gastrointestinal cancers: a national survey
  1. Christian Von Wagner1,
  2. Sandro Tiziano Stoffel1,
  3. Madeline Freeman1,
  4. Helga E Laszlo2,
  5. Brian D Nicholson3,
  6. Jessica Sheringham4,
  7. Dorothy Szinay1,
  8. Yasemin Hirst1
  1. 1 Research Department of Behavioural Science and Health, UCL, London, UK
  2. 2 UCLH Cancer Collaborative, UCLH, London, UK
  3. 3 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  4. 4 Department of Applied Health Research, University College London, London, UK
  1. Correspondence to Dr Christian Von Wagner; c.wagner{at}


Objectives In July 2017, UK National Institute for Health and Care Excellence (NICE) published a diagnostic guidance (DG30) recommending the use of faecal immunochemical tests (FITs) for symptomatic patients who do not meet the urgent referral pathway for suspected colorectal cancer (CRC). We assessed general practitioners’ (GP) awareness of DG30 in primary care 6 months after its publication.

Design and setting Cross-sectional online survey of GPs hosted by an English panel of Primary health care professionals.

Participants In December 2017, 1024 GPs registered on an online panel (M3) based in England took part in an online survey.

Outcomes and variables We investigated a number of factors including previous experience of using FIT and guaiac faecal occult blood tests (FOBTs), the number of urgent referrals for CRC that GPs have made in the last year and their sociodemographic and professional characteristics that could be associated with their self-reported awareness of the FIT diagnostic guidance.

Results Of the 1024 GPs who completed the survey, 432 (42.2%) were aware of the current recommendation but only 102 (10%) had used it to guide their referrals. Awareness was lowest in North West England compared with London (30.5% vs 44.9%; adjusted OR: 0.55, 95% CI 0.33 to 0.92). Awareness of the FIT guidance was positively associated with test usage after the NICE update (adjusted OR: 13.00, 95% CI 6.87 to 24.61) and having specialist training (adjusted OR: 1.48, 95% CI 1.05 to 2.08). The number of urgent referrals, the previous use of FOBt, GPs’ age and gender, work experience and practice size (both in terms of the number of GPs or patients at the practice) were not associated with awareness.

Conclusions Less than half of GPs in this survey recognised the current guidance on the use of FIT. Self-reported awareness was not systematically related to demographic of professional characteristics.

  • symptomatic
  • colorectal
  • two week wait
  • fecal immunochemical test
  • primary care

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  • Contributors CVW, YH and HEL conceived the study. CVW, YH, HEL, MF, BDN, JS, STS and DS contributed to the questionnaire design. STS, YH and CVW monitored data collection. STS and YH conducted the data analysis. YH, CVW and STS drafted the manuscript. CVW, YH, HEL, MF, BDN, JS, STS and DS commented and contributed to the further drafts.

  • Funding This project, as part of the qFIT pilot research study (IRAS 213710), was funded by the NHS England Cancer Vanguard Programme and delivered by the UCLH Cancer Collaborative. YH, STS and MF are funded by a Cancer Research UK Programme grant awarded to Prof Jane Wardle (C1418/A14134). BDN is funded by Macmillan as the GP Facilitator for Oxfordshire. JS was supported by theNational Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care North Thames at Barts Health NHS Trust. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

  • Competing interests None declared.

  • Ethics approval Ethical approval for the study was awarded by University College London Research Ethics Committee (11381/001).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data will be made available to other researchers after the acceptance for publication of the main findings of the qFIT pilot: GP acceptability survey. Data requests will be assessed on a case-by-case basis. Users will be required to complete a data sharing agreement.

  • Patient consent for publication Not required.