Formative Research on Knowledge and Preferences for Stool-based Tests compared to Colonoscopy: What Patients and Providers Think

  • John S. Luque
  • Kristin Wallace
  • Bridgette F. Blankenship
  • Lydia G. Roos
  • Franklin G. Berger
  • Nancy R. LaPelle
  • Cathy L. Melvin
Original Paper


The rates of colorectal cancer (CRC) screening in the U.S. remain below national targets, so many people at risk are not being screened. The objective of this qualitative research project was to assess patient and provider knowledge and preferences about CRC screening modalities and specifically the use of the fecal immunochemical test (FIT) as a first line screening choice. Nine focus groups were conducted with a medically underserved patient population and qualitative interviews were administered to their medical providers. Thematic analysis was used to synthesize key findings. Both providers and patients thought that the FIT would be a good option for CRC screening both as an individual choice and for an overall program approach. The test is less expensive and therefore more readily available for patients compared to colonoscopy. Overall, there was consensus that the FIT offers a reasonably priced, simple approach to CRC screening which has broad appeal to both providers and patients. Concerns identified by patients and providers included the possibility of false positives with the FIT which could be caused by test contamination or failing to perform the test properly. Patients also described feelings of disgust toward performing the FIT and difficulties in following the instructions. Study findings indicate provider and patient support for using the FIT for CRC screening at both the individual and system-wide levels of implementation. While barriers to the use of the FIT were listed, benefits of using the FIT were perceived as positive motivators to engage previously unscreened and uninsured or under-insured individuals in CRC screening.


Colorectal cancer Early detection of cancer Fecal immunochemical test Colonoscopy Medically underserved 



This project was supported by the South Carolina Cancer Alliance and the National Cancer Institute K07CA151864. We greatly appreciate the research participation of St. Luke’s Free Medical Clinic, the Dream Center Clinic, the Shifa Free Clinic, Polymedco, Inc., and Lowcountry Gastroenterology Associates. We acknowledge the leadership of Dr. Heather Brandt, Associate Dean of Professional Development and Associate Professor in the Arnold School of Public Health at the University of South Carolina, who chaired the committee at the South Carolina Cancer Alliance that made the pilot funding possible for this project.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was reviewed, approved, and continuously overseen by the Institutional Review Board at the Medical University of South Carolina. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018
Corrected publication June/2018

Authors and Affiliations

  • John S. Luque
    • 1
  • Kristin Wallace
    • 2
    • 3
  • Bridgette F. Blankenship
    • 2
  • Lydia G. Roos
    • 4
  • Franklin G. Berger
    • 5
  • Nancy R. LaPelle
    • 6
  • Cathy L. Melvin
    • 2
    • 3
  1. 1.Institute of Public Health, College of Pharmacy and Pharmaceutical SciencesFlorida A&M University, Science Research CenterTallahasseeUSA
  2. 2.Department of Public Health Sciences, College of MedicineMedical University of South CarolinaCharlestonUSA
  3. 3.Hollings Cancer CenterMedical University of South CarolinaCharlestonUSA
  4. 4.Health Psychology Ph.D. ProgramThe University of North Carolina at CharlotteCharlotteUSA
  5. 5.Center for Colon Cancer ResearchUniversity of South CarolinaColumbiaUSA
  6. 6.Division of Preventive and Behavioral MedicineUniversity of MassachusettsWorcesterUSA

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