Implementation of immunochemical faecal occult blood test in general practice: a study protocol using a cluster-randomised stepped-wedge design

Jakob Søgaard Juul, Flemming Bro, Nete Hornung, Berit Sanne Andersen, Søren Laurberg, Frede Olesen, Peter Vedsted, Jakob Søgaard Juul, Flemming Bro, Nete Hornung, Berit Sanne Andersen, Søren Laurberg, Frede Olesen, Peter Vedsted

Abstract

Background: Colorectal cancer is a common malignancy and a leading cause of cancer-related death. Half of patients with colorectal cancer initially present with non-specific or vague symptoms. In the need for a safe low-cost test, the immunochemical faecal occult blood test (iFOBT) may be part of the evaluation of such patients in primary care. Currently, Danish general practitioners have limited access to this test. The aim of this article is to describe a study that will assess the uptake and clinical use of iFOBT in general practice. Furthermore, it will investigate the diagnostic value and the clinical implications of using iFOBT in general practice on patients presenting with non-alarm symptoms of colorectal cancer.

Methods/design: The study uses a cluster-randomised stepped-wedge design and is conducted in the Central Denmark Region among 836 GPs in 381 general practices. The municipalities of the Region and their appertaining general practitioners will be included sequentially in the study during the first 7 months of the 1-year study period. The following intervention has been developed for the study: a mandatory intervention providing all general practitioners with a starting package of 10 iFOBTs, a clinical instruction on iFOBT use in general practice and online information material from the date of inclusion, and an optional intervention consisting of a continuous medical education on colorectal cancer diagnostics and use of iFOBT.

Discussion: This study is among the first and largest trials to investigate the diagnostic use and the clinical value of iFOBT on patients presenting with non-alarm symptoms of colorectal cancer. The findings will be of national and international importance for the future planning of colorectal cancer diagnostics, particularly for 'low-risk-but-not-no-risk' patients with non-alarm symptoms of colorectal cancer.

Trial registration: A Trial of the Implementation of iFOBT in General Practice NCT02308384 . Date of registration: 26 November 2014.

Keywords: Colorectal cancer; Denmark; Early diagnosis; FIT; Faecal occult blood test; General practice; Symptoms; iFOBT.

Figures

Fig. 1
Fig. 1
Stepped-wedge design used for the study. Most municipalities start out as usual care (C). Within the first seven months, all will cross over to intervention (I). Seven possible dates of inclusion are available; the 19 municipalities are randomly distributed between these
Fig. 2
Fig. 2
Flowchart of inclusion date for the participating municipalities

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