Barriers and facilitators to faecal immunochemical testing in symptomatic populations: A rapid systematic scoping review and gap analysis

Sienna Hamer-Kiwacz; Hannah Berntsson; George Galloway; Ann-Marie Tran; Jia Yun Tan; Daniel Hind; Matthew Kurien

doi:10.1111/jep.14120

Barriers and facilitators to faecal immunochemical testing in symptomatic populations: A rapid systematic scoping review and gap analysis

J Eval Clin Pract. 2024 Sep 18. doi: 10.1111/jep.14120. Online ahead of print.

Authors

Sienna Hamer-Kiwacz¹, Hannah Berntsson¹, George Galloway², Ann-Marie Tran², Jia Yun Tan², Daniel Hind¹, Matthew Kurien³

Affiliations

¹ Division of Population Health, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.
² The Medical School, The University of Sheffield, Sheffield, UK.
³ Division of Clinical Medicine, School of Medicine and Population Health, The University of Sheffield, Sheffield, UK.

PMID: 39291807
DOI: 10.1111/jep.14120

Abstract

Aim: Faecal immunochemical testing (FIT) is used to triage people with signs or symptoms of a colorectal cancer (CRC). Recent guidelines have recommended further research to improve access, uptake and return of FIT. This systematic scoping review aims to understand the barriers and facilitators to FIT testing in symptomatic patients.

Method: Qualitative, quantitative and mixed-methods studies published after September 2013 were included. MEDLINE, EMBASE and PsycINFO databases were searched to identify publications examining barriers and facilitators to FIT. Initially, the data underwent thematic analysis, and subsequently, factors were aligned to components of the Capability, Opportunity, Motivation, Behaviour model. All outcomes are presented in adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results: One thousand two hundred thirty-two papers were identified; 11 met the inclusion criteria. Barriers and facilitators were identified at the patient (e.g., knowledge), provider (e.g., general practitioner awareness) and service level (e.g., method of providing FIT kits). Factors were categorised into the subcomponents of the model: psychological capability (e.g., lack of FIT knowledge), reflective motivation (e.g., beliefs regarding FIT sampling and faeces being unhygienic) and automatic motivation (e.g., embarrassment, scary, anxiety provoking). Gaps in knowledge emerged in three domains: (1) patient experience, (2) FIT pathway and (3) healthcare professionals experience of FIT.

Conclusion: This systematic scoping review provides a summary of the literature on FIT uptake, and identified factors across multiple levels and components. To increase adherence to FIT completion within primary care, a multifaceted theory and evidence-based approach is needed to underpin future behavioural science interventions.

Keywords: diagnosis; medical research; primary care; systematic reviews.