In response to issues identified by London pathology laboratories, TCST launched a project to improve the quality of faecal immunohistochemical test (FIT) kit return for those being investigated for possible bowel cancer. In June 2021 the team launched a poster for GP practice staff explaining the correct way to complete and return a FIT. During the evaluation of the poster roll out, TCST have uncovered new potential areas for improving the FIT kit pathway and are hoping to join their data with other improvement projects to generate clear recommendations for London that will make the pathway more efficient and improve patient experience.

Across London Faecal Immunochemical Test (FIT) was implemented to assist with triaging bowel cancer referrals during the COVID-19 pandemic and ease the burden on stretched specialist teams. FIT is currently also used in bowel cancer screening and analyses poo samples to identify possible signs of bowel disease, including bowel cancer. Using FIT to triage those under investigation for a possible bowel cancer will mean that patients do not undergo unnecessary invasive tests and will speed up diagnosis for those who are more likely to have cancer.

Currently approximately 9% of all FIT kits sent to London labs are rejected due to incorrect labelling of kits, the wrong specimen container being used or incorrect/improper closure of the container resulting in leaked samples. When samples are rejected, the GP is notified and then the patient is asked to complete the kit again resulting in delays and a poor patient experience. In June 2021 TCST launched a poster for GP practice staff explaining the correct way to complete and return a FIT, believing the primary issue to be poor understanding of how FIT kits are completed and how this information is communicated to patients.

The team worked with London pathology labs, GP practice forums, the Healthy London Partnership Communications team and the outgoing CRUK GP primary care facilitators to gather data on FIT kit rejection and the staff experience of the FIT kit pathway including education, patient information and communication. Through the survey to practice staff the team were able to establish that although the activity on the Healthy London Partnership website for the poster had been encouraging at the start of the project most respondents to the survey hadn’t seen the poster at all. During an informal interview, one staff member cited the lack of space for posters in the surgery as an issue with poster information.

Although the London labs collected information on reasons for rejection in different ways, the most common reason for rejection was the sample not being collected in the faecal sample extraction device or wrong container entirely. From informal interviewing with laboratory staff it was flagged that some practices may be giving out stool sample pots instead of FIT kits and the survey confirmed that many staff are asked to give out both as part of their role.

Through the survey to practice staff, the team were able to establish that most staff would feel able (but not necessarily confident) in explaining a FIT kit to a patient (or family and friends – if not currently part of their role). However almost all respondents cited the patient information leaflet as their only source of information on FIT kit completion and there is variation in which information leaflet GP practices across London use. Additionally, the survey showed that most staff were unaware that the pan-London FIT leaflet is available in the top 11 London languages spoken.

Further work needs to be done to compare these findings to other London improvement projects for FIT but early recommendations from this work are:
• Development of in-person or online training to help practice staff (especially admin/ reception) correctly identify FIT kits and explain how to complete them.
• Better communication of both the FIT admin poster and the link to the translated pan-London FIT patient information leaflets.
• London screening programmes, cancer services, London pathology labs and PCNs to pool information on any FIT pathway quality improvement projects to get a clearer picture of the barriers to reducing the rejection rate.