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  • TEC14: What kind of training and information should be provided for the patient who uses FIT, or for his family/carer?
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What kind of training and information should be provided for the patient who uses FIT, or for his family/carer?

Authors: Mirjana Huic, Eleftheria Karampli, Silvia Florescu, Cristian Vladescu

Internal reviewers: Antonio Migliore, Pernilla Östlund, Frida Mowafi, Daniela d’Angela, Jesus Gonzalez

Information and education provided about CRC and CRC screening test and procedures is a key component of CRC screening programmes. Three phases in which information can be provided to participants are: Invitation phase (invitation for screening through invitation letters and leaflets); Reporting results page (screening test results are communicated to the participants), and Follow up phase (for people with positive FOBT results).

Personal invitation letters, preferably signed by the GP, should be used. Specific instructions on how to use FOBT kit or perform the bowel cleansing procedure need to be communicated to the patient. Patient should be able to understand written instructions how to perform these procedures. Written material should be clear, visually appealing and motivating.

 Recommendations from EU Guidelines {6} on different screening process steps are (see also TEC 14-Appendix 1):

“To communicate CRC screening information, including written instructions on how to use the FOBT kit or perform the bowel cleansing procedure, the language and text format used should be easy to understand and illustrations may be used. Ideally, written information (including written instructions) should not be the only source of information and should be complemented by visual communication instruments and/or oral interventions (VI - A).


Primary health care providers should be involved in the process of conveying information to people invited for screening (II - A).


In the context of an organised programme, personal invitation letters, preferably signed by the GP,

should be used. A reminder letter should be mailed to all non-attenders to the initial invitation (I - A).


Clear and simple instruction sheets should be provided with the kit (V - A).


Use of a non-tailored leaflet for the general population is advised; the leaflet should be included with the invitation letter. Information about CRC screening risks and benefits, CRC risks (incidence and risks factor), meaning of test results, potential diagnostic tests and potential treatment options should be included (VI - A).


Illustrations may be used, which would be particularly useful for minorities, the elderly or low-literacy participants (II - A).


Video/DVD may be a useful component in a multi-modal intervention in addition to written information, and would be particularly useful for the elderly, minorities and low literacy participants (I - B).


For the elderly, increasing the number of components of the multi-modal intervention and the period over which these components are provided may be more effective (I - B).


A computer-based decision aid could be used to help both the general population and specific groups to make informed decisions about CRC screening (I - B). The computer-based decision aid should be “user-friendly” and designed to fit with the computer abilities of the target population (general or specific groups).


If possible, all information provided by the screening programme should be available on a specific web site. This information should be regularly updated (VI - A).


Patient navigation could be used within CRC screening programmes, particularly to reach subgroups of the population such as the elderly, those with low literacy, and medically underserved patients. When used with minorities, the patient navigator should be from a similar ethnic background and/or live in the same community as the participant (I - B).


Verbal face-to-face interventions with a nurse or physician could be used to improve knowledge and participation. They would be useful to reach subgroups of the population such as the elderly, minorities and those with low literacy (I - A).


Nurses and primary care practitioners (GPs) should receive adequate training to be able to help people make informed decisions about CRC screening (VI - A).


CRC screening programmes should work closely with advocacy groups and the media and provide them with up-to-date, accurate and comprehensive information about CRC and CRC screening (VI - A).


A telephone or ideally a verbal face-to-face intervention, e.g. nurse or physician intervention, should be used to inform a patient of a positive screening test result, as obtaining such a result could be a source of psychological distress for the patient. A letter informing the patient should not be used as the only way of notifying a positive result (VI - A).


To increase endoscopy follow-up after a positive FOBT and facilitate communication, CRC

screening programmes should, where possible:

- Use a reminder-feedback and an educational outreach intervention targeted to the primary

care physician (II - A);

- Provide patients with a written copy of their screening report (II - A);

- Facilitate patient consultation with a gastroenterologist (V - B);

- Describe the follow-up procedure, make the follow-up testing more convenient and

accessible (VI - A); and

- Use direct contact intervention to address psychological distress and other specific barriers.

(V - B).


Each endoscopy service must have a policy for pre-assessment that includes a minimum data set relevant to the procedure. There should be documentation and processes in place to support and monitor the policy (III - B).


The endoscopy service must have policies that guide the consent process, including a policy on withdrawal of consent before or during the endoscopic procedure (VI - B).


Before leaving the endoscopy unit, patients should be informed about the outcome of their procedure and given written information that supports a verbal explanation (VI - A).


The outcome of screening examinations should be communicated to the primary care doctor (or equivalent) so that it becomes part of the core patient record (VI - B).


Ideally, the invitation letter and the letter used for notification of a positive result should be sent with a leaflet and should encourage participants to read it (VI - A).


Certain basic information, e.g. logistic/organisational information, description of the screening test, harms and benefits of screening, information about the FOBT kit and the bowel cleansing procedure, must be included in the invitation/result letter in case a person reads only the letter and not the leaflet (VI - A).

pdf10936.TEC-14 Appendix 1

Huic M et al. Result Card TEC14 In: Huic M et al. Description and technical characteristics of technology In: Jefferson T, Cerbo M, Vicari N [eds.]. Fecal Immunochemical Test (FIT ) versus guaiac-based fecal occult blood test (FOBT) for colorectal cancer screening [Core HTA], Agenas - Agenzia nazionale per i servizi sanitari regionali; 2014. [cited 16 June 2021]. Available from: