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Research ArticleOriginal Research

Patients’ Difficulties with Five Different Fecal Immunochemical Tests

Jeanette M. Daly, Yinghui Xu and Barcey T. Levy
The Journal of the American Board of Family Medicine November 2024, 37 (6) 1014-1026; DOI: https://doi.org/10.3122/jabfm.2023.230469R1
Jeanette M. Daly
From the Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA (JD, YX, BTL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (BTL); Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA (BTL).
RN, PhD
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Yinghui Xu
From the Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA (JD, YX, BTL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (BTL); Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA (BTL).
MS
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Barcey T. Levy
From the Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA (JD, YX, BTL); Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA (BTL); Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA (BTL).
PhD, MD
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  • Article
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Article Figures & Data

Tables

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    Table 1.

    Demographic Characteristics of Study Participants

    Total (n = 2,148)
    Mean (SD) or n (%)
    Age, mean (SD), years62.8 (8.0)
     <651,273 (59.3)
     65 to 75719 (33.5)
     >75156 (7.3)
    Sex
     Female1,353 (63.0)
     Male795 (37.0)
    Race
     Black160 (7.4)
     White1,787 (83.2)
     Other201 (9.4)
    Ethnicity
     Hispanic403 (18.8)
     Non-Hispanic1,731 (80.6)
     Unknown14 (0.6)
    Education
     <8th grade81 (3.8)
     HS/GED428 (19.9)
     College or higher1,621 (75.5)
     Not reported18 (0.8)
    Income
     <$40,000636 (29.6)
     $40,000 to <$80,000483 (22.5)
     $80,000 or more942 (43.9)
     Not reported87 (4.0)
    Cigarette smoker
     Current120 (5.6)
     Former629 (29.3)
     Never1,390 (64.7)
     Not reported9 (0.4)
    BMI
     <18.5 (underweight)20 (0.9)
     18.5–24.9 (healthy weight)630 (29.3)
     25.0–29.9 (overweight)736 (34.3)
     ≥30.0 (obesity)757 (35.2)
     Missing5 (0.2)
    Watson method score
     Abnormal581 (27.1)
     Normal1,567 (72.9)
    Mendes-Santos method score
     Abnormal453 (21.1)
     Normal2,148 (78.9)
    • Abbreviations: SD, Standard Deviation; HS/GED, High School/General Educational Development; BMI, Body Mass Index.

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    Table 2.

    FIT Collection Difficulties (n = 2,148)

    Hemoccult ICTHemosure iFOBOC-Auto Micro FITOC-Light S FITQuickVue iFOB
    Difficultiesn (%)n (%)n (%)n (%)n (%)
    None1044 (48.6)1540 (70.0)1454 (67.7)1419 (66.1)1435 (66.8)
    Getting sample on stick172 (8.0)
    Getting sample in collection window306 (14.2)
    Collection window was too small401 (18.7)
    It was messy450 (20.9)71 (3.3)79 (3.7)67 (3.1)66 (3.1)
    Instructions were unclear73 (3.4)23 (1.1)21 (1.0)16 (0.7)23 (1.1)
    Getting the cap off66 (3.1)53 (2.5)165 (7.7)43 (2.0)
    Deciding which cap to openNot askedNot asked137 (6.4)
    Probing the stool multiple times114 (5.3)110 (5.1)108 (5.0)
    Scraping the stool multiple times178 (8.3)
    Liquid spilled from the tube20 (0.9)11 (0.5)4 (0.2)9 (0.4)
    Other113 (5.3)64 (3.0)103 (4.8)80 (3.7)68 (3.2)
    • *Could check any that applied.

    • Abbreviations: ICT, Immunochemical Test; iFOB, Immunochemical Fecal Occult Blood Test; FIT, Fecal Immunochemical Test.

    • View popup
    Table 3.

    FIT Collection Difficulty and FIT Errors**

    OverallNo DifficultySome Difficulty
    N (%)N (%)N (%)P-values
    Hemoccult ICT errors0.027*
     Yes66 (3.2)29 (2.4)37 (4.2)
     No2,005 (96.8)1,156 (97.6)849 (95.8)
    Hemosure iFOB errors0.001*
     Yes52 (2.5)31 (1.9)21 (4.7)
     No1,996 (97.5)1,570 (98.1)426 (95.3)
    OC-Light S FIT errors<0.001†
     Yes9 (0.4)1 (0.1)8 (1.6)
     No2,041 (99.6)1,545 (99.9)496 (98.4)
    QuickVue iFOB errors<0.001*
     Yes54 (2.6)26 (1.7)28 (5.5)
     No1,994 (97.4)1,510 (98.3)484 (94.5)
    • ↵*χ2 for some difficulty versus no difficulty.

    • ↵†Fisher’s exact test for some difficulty versus no difficulty.

    • ↵**No errors were noted for OC-Auto, because all vials were sent to the main pathology laboratory for analysis, even if it appeared no stool was in the vial.

    • Abbreviations: ICT, Immunochemical Test; iFOB, Immunochemical Fecal Occult Blood Test; FIT, Fecal Immunochemical Test.

    • View popup
    Table 4.

    Factors Associated with Having Some Difficulty versus No Difficulty in Collection of FIT Sample (n = 2,148)*

    Univariable ModelMultivariable Model†
    FactorsOdds Ratio (95% CI)P-valuesOdds Ratio (95% CI)P-values
    FIT brand<0.0001
     Hemoccult ICT (n = 2,071)4.17 (3.49-4.99)<0.00014.05 (3.34-4.85)<0.0001
     Hemosure iFOB (n = 2,048)0.74 (0.61-0.91)0.0030.72 (0.59-0.88)0.001
     OC-Light S FIT (n = 2,050)0.99 (0.81-1.20)0.8870.98 (0.81-1.19)0.832
     QuickVue iFOB (n = 2,048)1.02 (0.84-1.24)0.8380.98 (0.81-1.19)0.827
     OC-Auto Micro FIT (n = 2,052)ReferenceReference
    Age, years0.002
     <65 (n = 1,273)0.65 (0.52-0.81)0.0010.65 (0.51-0.83)0.001
     65 to 75 (n = 719)ReferenceReference
     >75 (n = 156)0.79 (0.52-1.20)0.2650.72 (0.46-1.14)0.158
    Education0.045
     ≤8th grade (n = 81)0.76 (0.43-1.34)0.3421.00 (0.52-1.93)0.996
     HS/GED (n = 428)0.56 (0.43-0.73)<0.00010.68 (0.49-0.93)0.015
     College or higher (n = 1,621)ReferenceReference
    Income0.007
     <$40,000 (n = 636)0.34 (0.23-0.51)<0.00010.60 (0.44-0.81)0.001
     $40,000 to <$80,000 (n = 483)0.74 (0.48-1.14)0.1740.84 (0.63-1.13)0.249
     $80,000 or more (n = 942)ReferenceReference
    FIT errors^
     Yes4.28 (2.80-6.55)<0.00013.90 (2.46-6.17)<0.0001
     NoReferenceReference
    Ethnicity
     Hispanic (n = 403)0.65 (0.49-0.85)0.002
     Non-Hispanic/unknown (n = 1,745)Reference
    Sex
     Female (n = 1,353)0.97 (0.68-1.37)0.851
     Male (n = 795)Reference
    Race
     White (n = 1,787)1.22 (0.81-1.81)0.341
     Others (n = 201)0.90 (0.54-1.52)0.699
     Black (n = 160)Reference
    Watson method score
     Abnormal (n = 581)1.24 (0.85-1.81)0.266
     Normal (n = 1,567)Reference
    Mendes-Santos method score
     Abnormal (n = 453)1.17 (0.77-1.76)0.468
     Normal (n = 1,695)Reference
    • *Outcome variable having “some difficulty” versus “no difficulty” to collect the sample; Original scores ranged from 1 = “very easy” to 5 = “very difficult” by each FIT. Scores were collapsed into a dichotomous variable with scores of 2, 3, 4, and 5 being categorized as having “some difficulty,” and a score of 1 categorized as “no difficulty.”

    • ↵†Generalized Linear Mixed Model.

    • ^Each FIT was categorized as either having an error or not.

    • Abbreviations: ICT, Immunochemical Test; iFOB, Immunochemical Fecal Occult Blood Test; FIT, Fecal Immunochemical Test; CI, Confidence Interval.

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The Journal of the American Board of Family     Medicine: 37 (6)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 6
November-December 2024
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Patients’ Difficulties with Five Different Fecal Immunochemical Tests
Jeanette M. Daly, Yinghui Xu, Barcey T. Levy
The Journal of the American Board of Family Medicine Nov 2024, 37 (6) 1014-1026; DOI: 10.3122/jabfm.2023.230469R1

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Patients’ Difficulties with Five Different Fecal Immunochemical Tests
Jeanette M. Daly, Yinghui Xu, Barcey T. Levy
The Journal of the American Board of Family Medicine Nov 2024, 37 (6) 1014-1026; DOI: 10.3122/jabfm.2023.230469R1
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