Result card

  • ORG10: How are the other interest groups taken into account in the planning / implementation of FIT?

How are the other interest groups taken into account in the planning / implementation of FIT?

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. Two articles were found to be relevant to this question. We found additional information by an internet search of grey literature performed on 23 May 2013 via the search engine Google. It was performed by investigator using key words specific to this question (“professional involved in FIT screening”, “stakeholders’ participation in FIT screening”, “stakeholders’ engagement in FIT screening”, “partners’ participation in FIT screening”, “the role of manufacturers in FIT screening”, “the role of municipalities in FIT screening”, “the role of pharmacists in FIT screening” etc.). Five grey literature sources are referred to in these results.


Wide spectrums of stakeholders are engaged in planning and implementation of FIT. Usually stakeholders, involved in that process, vigorously defend their many interests, including patients, health professionals, politicians and industry {38}. New Zeland’s report from University of Otago agrees that the relevant stakeholders have to be included already in the early process, when screening program is in stage of designing. Key stakeholders in their specific area include Consumers, Maori, Pacific people, Surgeons, Gastroenterologists, Pathologists, Laboratories, Academics, radiation specialists, oncologists, Potential providers of any services such as laboratories, private specialists, FOBT manufacturers General practitioners, National Screening Unit Cancer NGOs, DHBs, Ministry of Health, Treasury, Minister of Health {39}. That involvement of a wide range of stakeholders is essential, confirms also a study of Geddies et. al., who claim that those, who participate in health policy decision making may range from senior government and administrative officials, trained methodologists and clinicians, program managers, or community stakeholders {40}. UK has also defined roles and responsibilities of stakeholders in their bowel cancer screening programme. Main stakeholders that have been mentioned are:

•             national office (for example: they develop quality assurance (QA), develop and monitor the effectiveness of QA etc.),

•             strategic health authorities (SHAs), who have the role of coordination of the process of selection of screening centres and recommendation of potential centres to the national office to ensure that their responsible populations are included in the screening programme,

•             primary care trusts (PCTs), who are involved in the process of selecting proposed screening centres and are responsible for securing and funding the treatment of cancers detected by the screening programme,

•             general practice (screening centres are responsible for disseminating information about the screening programme to primary care teams, e.g. through PCTs, practice visits or regular GP/practice manager meetings; once screening has begun, some people receiving invitations and test kits may want the opportunity to discuss the screening process with their GPs),

•             program hubs (their main roles are: manage call and recall for the screening programme, provide a telephone helpline for people invited for screening, despatch and process test kits, send test result letters and notify GPs, book the first appointment at an SSP (specialist screening practitioner) clinic for patients with an abnormal test result),

•             screening centres (their roles are: arrange colonoscopy appointments for patients with an abnormal test result or who are scheduled for polyp surveillance, ensure appropriate follow up or treatment for patients after colonoscopy etc. and also provide information about the screening programme for the local health community, promote the screening programme to the general public in their locality, provide information and support for local people in completing the FOB test (on referral from the programme hub), ensure that data are collected to enable audit and evaluation of the screening programme) and

•             acute trusts (provide endoscopy services, but which will not be developing into screening centres) {41}.


Spanish study of Carballo and Munoz-Navas (2012) indicated that one of the main reasons of thriving and active population based screening of high quality in Spain was also a good collaboration between key institutions, which are integrated in pre-existing Cancer Screeing Program Network (CSPN). The CSPN is formed by the people in charge of cancer screening programs in the Autonomous regions, who are experts in Public Health; its main objective is the exchange of experiences between managers of population based programs of early cancer detection. They organize the CSPN annual meeting, to which specialists in digestive disorders, pathologists, radiologists, surgeons, primary care physicians and oncologists participate. In 2007 this special meeting was dedicated to establish the necessary recommendations for the planning and setting up of demographically-based organized programs for the prevention of CRC {42}.

Some literatures have also been found on the importance and the role of pharmacists. In Canada pharmacists help those, who do not have a health care provider to access screening for colorectal cancer by: dispensing program-branded FOBT kits to eligible unattached participants, providing information about the importance of screening for colorectal cancer etc. {43, 44}.

Survey, implemented among 11 European countries, has also provided some important results. Only 5 countries indicated the stakeholder’s involvement (Austria, Italy, Scotland, France and Slovenia). Only 3 countries out of those five mentioned use FIT technology (Scotland, Italy and Slovenia). Scotland indicated that stakeholders in their country include NHS Education Scotland, Healthcare Improvement Scotland, 14 territorial NHS Boards, NHS National Services Scotland, Central Legal Office, Information Services Division, National Services Division, Health Facilities Scotland, Bowel Cancer UK. Italy only mentioned the important role of GPs, who advise the target population about the relevance/importance of screening. Slovenia indicated the following 5 important stakeholders:

1.            NIPH (National Institute of Public Health) Slovenia as Svit leading program.

2.            Authorized contractual partners: Histopatological centres, colonoscopy centres.

3.            Payer: Health Insurance Institute of Rep. Slovenia.

4.            Tenders for promotions program (web pages, IT support).

5.            Pharmaceutical industry: Tenders for iFOBT, laxative Movi Prep, laboratory materials.

Little information exists about the interest groups/ stakeholders, who are or have to be taken into account in the planning / implementation of FIT. No study was found that would indicate general information on each stakeholder’s involvement or their interaction that could be referred to all European countries. Stakeholders’ involvement and role are, naturally, country specific due to specific countries programme, but little information was found also among grey literature.

Rupel P et al. Result Card ORG10 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: