Evidence map›Paper›PMID 36123111›Full record

ArticleBMJ open2022

Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study.

Natalia Calanzani, Merel M Pannebakker, Max J Tagg, Hugo Walford, Peter Holloway, Niek de Wit, Willie Hamilton, Fiona M Walter

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
3citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 36% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

3 citing papers in PubMed, 1 synthesis or guideline pooled it, 4 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 6 institutions in 2 countries.

Natalia CalanzaniThe Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK nm719@medschl.cam.ac.uk.ORCID 0000-0002-5068-2543
Merel M PannebakkerThe Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.ORCID 0000-0003-2918-0570
Max J TaggSchool of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK.ORCID 0000-0003-0341-3284
Hugo WalfordSchool of Clinical Medicine, University College London, London, UK.ORCID 0000-0001-9655-9674
Peter HollowayEast of England Cancer Alliances, Cambridge, UK.
Niek de WitJulius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands.
Willie HamiltonUniversity of Exeter Medical School, University of Exeter, Exeter, UK.ORCID 0000-0003-1611-1373
Fiona M WalterThe Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.ORCID 0000-0002-7191-6476
University of Cambridge · GBLondon Cancer · GBQueen Mary University of London · GBUniversity College London · GBUniversity of Exeter · GBUtrecht University · NL

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe faecal immunochemical test (FIT) was introduced to triage patients with lower-risk symptoms of colorectal cancer (CRC) in English primary care in 2018. While there is growing evidence on its utility to triage patients in this setting, evidence is still limited on how official FIT guidance is being used, for which patients and for what symptoms. We aimed to investigate the use of FIT in primary care practice for lower-risk patients who did not immediately meet criteria for urgent referral.

designA prospective, descriptive study of symptomatic patients offered a FIT in primary care between January and June 2020.

settingEast of England general practices.

participantsConsenting patients (aged ≥40 years) who were seen by their general practitioners (GPs) with symptoms of possible CRC for whom a FIT was requested. We excluded patients receiving a FIT for asymptomatic screening purposes, or patients deemed by GPs as lacking capacity for informed consent. Data were obtained via patient questionnaire, medical and laboratory records. PRIMARY AND SECONDARY OUTCOME MEASURES: FIT results (10 µg Hb/g faeces defined a positive result); patient sociodemographic and clinical characteristics; patient-reported and GP-recorded symptoms, symptom severity and symptom agreement between patient and GP (% and kappa statistics).

resultsComplete data were available for 310 patients, median age 70 (IQR 61-77) years, 53% female and 23% FIT positive. Patients most commonly reported change in bowel habit (69%) and fatigue (57%), while GPs most commonly recorded abdominal pain (25%) and change in bowel habit (24%). Symptom agreement ranged from 44% (fatigue) to 80% (unexplained weight loss). Kappa agreement was universally low across symptoms.

conclusionAlmost a quarter of this primary care cohort of symptomatic patients with FIT testing were found to be positive. However, there was low agreement between patient-reported and GP-recorded symptoms. This may impact cancer risk assessment and optimal patient management in primary care.

Indexed as

Colorectal NeoplasmsGeneral PracticeAgedFatigueFemaleHumansMaleOccult BloodSensitivity and SpecificityAdult oncologyGastrointestinal tumoursPRIMARY CARE

Identifiers

PMID36123111
PMCPMC9486301
OpenAlexW4296418809

What OpenQuestion holds

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LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.