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Patient-reported and doctor-reported symptoms when faecal immunochemical tests are requested in primary care in the diagnosis of colorectal cancer and inflammatory bowel disease: a prospective study.
BMC Fam Pract. 2020 Jul 01; 21(1):129.BF

Abstract

BACKGROUND

Rectal bleeding and a change in bowel habits are considered to be alarm symptoms for colorectal cancer and they are also common symptoms for inflammatory bowel disease. However, most patients with these symptoms do not have any of these diseases. Faecal immunochemical tests (FITs) for haemoglobin are used as triage tests in Sweden and other countries but little is known about the symptoms patients have when FITs are requested.

OBJECTIVE

Firstly, to determine patients' symptoms when FITs are used as triage tests in primary care and whether doctors record the symptoms that patients report, and secondly to evaluate the association between symptoms, FIT results and possible prediction of colorectal cancer or inflammatory bowel disease.

METHODS AND MATERIALS

This prospective study included 364 consecutive patients for whom primary care doctors requested a FIT. Questionnaires including gastrointestinal symptoms were completed by patients and doctors.

RESULTS

Concordance between symptoms reported from patients and doctors was low. Rectal bleeding was recorded by 43.5% of patients versus 25.6% of doctors, FITs were negative in 58.3 and 52.7% of these cases respectively. The positive predictive value (PPV) of rectal bleeding recorded by patients for colorectal cancer or inflammatory bowel disease was 9.9% (95% confidence interval [CI] 5.2-14.7); for rectal bleeding combined with a FIT the PPV was 22.6% (95% CI 12.2-33.0) and the negative predictive value (NPV) was 98.9% (95% CI 96.7-100). For patient-recorded change in bowel habits the PPV was 6.1% (95% CI 2.4-9.8); for change in bowel habits combined with a FIT the PPV was 18.2% (95% CI 9.1-30.9) and the NPV 100% (95% CI 90.3-100).

CONCLUSIONS

Doctors should be aware that, during consultations, they do not record all symptoms experienced by patients. FITs requested in primary care, when found positive, may potentially be of help in prioritising referrals, also when patients present with rectal bleeding or change in bowel habits.

Authors+Show Affiliations

Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Östersund Hospital, Umeå University, Umeå, Sweden. cecilia.hogberg@umu.se.Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, Umeå, Sweden.Department of Surgical and Perioperative Sciences, Umeå University, Umeå, Sweden.Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Östersund Hospital, Umeå University, Umeå, Sweden.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32611307

Citation

Högberg, Cecilia, et al. "Patient-reported and Doctor-reported Symptoms when Faecal Immunochemical Tests Are Requested in Primary Care in the Diagnosis of Colorectal Cancer and Inflammatory Bowel Disease: a Prospective Study." BMC Family Practice, vol. 21, no. 1, 2020, p. 129.
Högberg C, Karling P, Rutegård J, et al. Patient-reported and doctor-reported symptoms when faecal immunochemical tests are requested in primary care in the diagnosis of colorectal cancer and inflammatory bowel disease: a prospective study. BMC Fam Pract. 2020;21(1):129.
Högberg, C., Karling, P., Rutegård, J., & Lilja, M. (2020). Patient-reported and doctor-reported symptoms when faecal immunochemical tests are requested in primary care in the diagnosis of colorectal cancer and inflammatory bowel disease: a prospective study. BMC Family Practice, 21(1), 129. https://doi.org/10.1186/s12875-020-01194-x
Högberg C, et al. Patient-reported and Doctor-reported Symptoms when Faecal Immunochemical Tests Are Requested in Primary Care in the Diagnosis of Colorectal Cancer and Inflammatory Bowel Disease: a Prospective Study. BMC Fam Pract. 2020 Jul 1;21(1):129. PubMed PMID: 32611307.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Patient-reported and doctor-reported symptoms when faecal immunochemical tests are requested in primary care in the diagnosis of colorectal cancer and inflammatory bowel disease: a prospective study. AU - Högberg,Cecilia, AU - Karling,Pontus, AU - Rutegård,Jörgen, AU - Lilja,Mikael, Y1 - 2020/07/01/ PY - 2020/01/16/received PY - 2020/06/15/accepted PY - 2020/7/3/entrez PY - 2020/7/3/pubmed PY - 2020/7/3/medline KW - Colorectal neoplasms KW - Faecal immunochemical test KW - Gastrointestinal symptoms KW - Occult blood KW - Primary care KW - Rectal bleeding SP - 129 EP - 129 JF - BMC family practice JO - BMC Fam Pract VL - 21 IS - 1 N2 - BACKGROUND: Rectal bleeding and a change in bowel habits are considered to be alarm symptoms for colorectal cancer and they are also common symptoms for inflammatory bowel disease. However, most patients with these symptoms do not have any of these diseases. Faecal immunochemical tests (FITs) for haemoglobin are used as triage tests in Sweden and other countries but little is known about the symptoms patients have when FITs are requested. OBJECTIVE: Firstly, to determine patients' symptoms when FITs are used as triage tests in primary care and whether doctors record the symptoms that patients report, and secondly to evaluate the association between symptoms, FIT results and possible prediction of colorectal cancer or inflammatory bowel disease. METHODS AND MATERIALS: This prospective study included 364 consecutive patients for whom primary care doctors requested a FIT. Questionnaires including gastrointestinal symptoms were completed by patients and doctors. RESULTS: Concordance between symptoms reported from patients and doctors was low. Rectal bleeding was recorded by 43.5% of patients versus 25.6% of doctors, FITs were negative in 58.3 and 52.7% of these cases respectively. The positive predictive value (PPV) of rectal bleeding recorded by patients for colorectal cancer or inflammatory bowel disease was 9.9% (95% confidence interval [CI] 5.2-14.7); for rectal bleeding combined with a FIT the PPV was 22.6% (95% CI 12.2-33.0) and the negative predictive value (NPV) was 98.9% (95% CI 96.7-100). For patient-recorded change in bowel habits the PPV was 6.1% (95% CI 2.4-9.8); for change in bowel habits combined with a FIT the PPV was 18.2% (95% CI 9.1-30.9) and the NPV 100% (95% CI 90.3-100). CONCLUSIONS: Doctors should be aware that, during consultations, they do not record all symptoms experienced by patients. FITs requested in primary care, when found positive, may potentially be of help in prioritising referrals, also when patients present with rectal bleeding or change in bowel habits. SN - 1471-2296 UR - https://www.unboundmedicine.com/medline/citation/32611307/Patient-reported_and_doctor-reported_symptoms_when_faecal_immunochemical_tests_are_requested_in_primary_care_in_the_diagnosis_of_colorectal_cancer_and_inflammatory_bowel_disease:_a_prospective_study L2 - https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-020-01194-x DB - PRIME DP - Unbound Medicine ER -
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