Result card

  • ORG9: How is FIT accepted?

How is FIT accepted?

Authors: Principal investigators: Valentina Prevolnik Rupel, Nika Berlic Investigators: Dominika Novak Mlakar, Taja Čokl, Plamen Dimitrov, Marta López de Argumedo

Internal reviewers: Americo Cicchetti, Daniela D'Angela, Marco Marchetti

Acknowledgments: /

Analysis of selected studies extracted from the basic literature search. Five articles were found to be relevant to this question.


Acceptance of FIT by patients

Young and Cole in their study (2007) found out that FITs overcome most of the disadvantages presented by gFOBT, are superior to gFOBT in terms of participation as well as performance and concluded that  FIT should replace gFOBT in two-step screening. FIT technology simplifies the testing process, removes the need for diet and drug restrictions, provides for preferred and more acceptable stool-sampling tools such as brushes or probes rather than a wooden spatula, and is possible with collecting fewer fecal samples. Most branded versions of FIT require fewer than three fecal samples, the recommended number for gFOBT {33}. In study of Cole et. al. (2003) the removal of dietary restrictions has been shown to enhance participation in screening with FIT relative to gFOBT, by 28% {35}. Changing to a brush-sampling method also simplifies the process and enhances participation by 30%. Together, these two advances increase population participation by 66% {34}.

Another population-based study compares perceived test burden and willingness to return for a successive screening round among gFOBT, FIT and FS (flexible sigmoidoscopy) in an average-risk population. All three screening tests were well accepted among participants, given the large proportion of screenees willing to return for successive screening rounds and the positive recommendation for screening that most subjects intended to give their family and/or friends. FIT was perceived as slightly less burdensome than gFOBT screening due to less reported discomfort during faecal collection and test performance. The number of faecal samples required may explain the difference in discomfort during faecal collection, as gFOBT had to be performed on three consecutive bowel movements and FIT was a one-sample test. The authors concluded that gFOBT, FIT and FS are well accepted screening tests among participants. FIT slightly outperforms gFOBT with a lower level of reported discomfort and overall burden. Both FOBTs were better accepted than FS screening {36}. Better acceptance of FIT in comparison to gFOBT was also observed in Allison’s study {37}.

Acceptance of FIT by personnel and organization

There are little information about the acceptance of FIT by health personnel and the organization. Nevertheless, it has been demonstrated that the higher acceptability of FIT among patients is an important argument for choosing FIT in preference to gFOBT as the screening method for a nation-wide screening programme, apart from additional arguments regarding test performance characteristics. Therefore, the Dutch Health Council recently recommended introducing a nation-wide FIT-based CRC screening programme {36}.

The survey result gave additional information. Scotland indicated that FIT test is new in the country and not widely accepted by doctors. Therefore patients can choose between FOBT and colonoscopy.

There are little information about the acceptance of FIT by health personnel and the organization.

Rupel P et al. Result Card ORG9 In: Rupel P et al. Organisational aspects 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: