Could It Be Colorectal Cancer? General Practitioners' Use of the Faecal Occult Blood Test and Decision Making – A Qualitative Study

Cecilia Högberg; Eva Samuelsson; Mikael Lilja; Eva Fhärm

BMC Fam Pract. 2015;16(153)

Conclusion

Careful listening to the patient's history was essential for prompting suspicion of CRC and for making a decision about which patients to refer. The iFOBT was used frequently as support, but there was a considerable variation in the handling of the results. The diagnostic process can be described as navigating uncertain waters with safety margins, while striving to keep the patient's best interests in mind.

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Abbreviations
CRC: Colorectal cancer, GP: General Practitioner, FOBT: Faecal occult blood test, iFOBT: Immunochemical faecal occult blood test

Acknowledgements
We thank the participating physicians for their interest and for their time. This study was made possible by unrestricted grants from the Region Jämtland Härjedalen, the Regional Cancer Centre North, the Northern County Councils (Visare Norr), the Swedish Society of Medicine, the Cancer Research Foundation in Northern Sweden, and the Jämtland County Cancer and Nursing Fund.

Table 1. An example of the analytical process used to process the interview information
Meaning unit	Condensed meaning unit	Code	Category
I assume there's also a certain degree of intuition involved. Like when something is not quite right with a person I've seen before.	Intuition involved when a patient has been seen before.	Intuition involved.	Careful listening—with awareness of the pitfalls
It (iFOBT^a) could be important because it can back up my theory if I already, based on other symptoms and so on, have an idea.	IFOBT results can back me up if I, based on other factors, have a general idea.	IFOBT can back up a decision to investigate or not.	Tests can help—the iFOBT can also complicate the diagnosis
If I don't feel quite certain about an IBS^b diagnosis, I refer for bowel imaging.	Bowel imaging if the IBS diagnosis feels uncertain.	Bowel imaging if an uncertain IBS diagnosis.	To refer or not to refer—safety margins are necessary
Perhaps I can keep a cool head for longer now, if I think it looks harmless.	Keep a slightly cooler head now if it looks benign.	Keeping cooler head now.	Growing more confident—but also more humble