P2346 - An Educational Quality Improvement Initiative to Address Use of gFOBT, FIT and FIT-DNA by Healthcare Professionals

Kafayat Busari, MS, MD¹, Marc Bernstein, MD², Renee Williams, MD, FACG^3
1Florida State UniversitySarasota Memorial Hospital, Sarasota, FL; ²Florida State University, Sarasota Memorial Hospital, Sarasota, FL; ³New York University Langone Medical Center, New York, NY

Introduction: gFOBT, FIT, FIT-DNA are non-invasive colorectal cancer screening tools often used inappropriately. Furthermore, clinical decisions are then predicated on these test results leading to consequences ranging from delay of healthcare to unnecessary invasive procedures. The purpose of this project was to identify misconceptions among health care providers, and to educate utilizing interventions aimed at developing life-long evidence-based practices regarding correct use, understanding and knowledge of non-invasive colorectal cancer screening tests.

Methods: Three 1-hour long interactive lectures based on current guidelines were conducted and made available online to internal and emergency medicine residents, medical students, nurses and physician assistants. Participants completed a pre- and post-test questionnaire, with questionnaires paired to each individual. Question stems were created to focus on topics gauging ability to assess higher level of thinking, recall, and knowledge of evidence based medicine regarding gFOBT, FIT and FIT-DNA. Participants were also asked frequency in using screening tests for symptoms of abdominal pain, hematochezia or melena and if educational intervention was informative. Data was analyzed using descriptive statistics and paired T tests to assess an improvement in knowledge.

Results: 85 participants were involved including residents within internal (n=28) and emergency medicine (n=13), 3rd and 4th year medical students (n=24), physician assistants (n=8) and clinical nursing staff (n=12). Most common misconceptions identified were screening timeline guidelines, when and how to perform tests and next-best step following positive stool test results. (Table 1) The use of stool based screening tests are commonly used for symptoms such as hematochezia or melena. Pre and post-test averages showed statistically significant improvement after educational intervention in all groups. (Graph 1)

Discussion: There is a gap in knowledge regarding appropriate use of stool- based testing for colorectal cancer screening. A simple educational intervention based on current guidelines showed a statistically significant increase in knowledge in medical students, residents, physician assistants and nursing staff. 100% of participants who responded found the interactive lecture and questionnaire informative. Future plans include assessing knowledge retention 3 months after initial intervention along with comparing the use of stool based tests before and after the intervention.


Figure: Graph 1. Before and After Educational Intervention Questionnaire Results
Blue=Pre-Test Green= Post-Test

Test Question by Concept	Internal Residents n=28 (% participants)	Emergency Residents n=13 (% participants)	Medical Students n=24 (% participants)	Physician Assistant n=8 (% participants)	Nursing Staff n=12 (% participants)	Total n=85 ( % participants)
Question 2: Required dietary and medication restrictions before using gFOBT	13 (46%)	1 (7.6%)	15 (62%)	2 (25%)	4 (33%)	25 (29%)
Question 3: Types of patients who should not undergo screening using stool-based testing	19 (67%)	7 (53%)	7 (29%)	4 (50%)	8 (66%)	45 (52%)
Question 4: Method of how and when to perform stool- based testing	20 (71%)	6 (46%)	17 (71%)	7 (87%)	9 (75%)	59 (69%)
Question 5: Limitations of stool- based testing	5 (17%)	6 (46%)	9 (37%)	2 (25%)	5 (41%)	27 (32%)
Question 6: # of samples required for test analysis and why	18 (64%)	8 (61%)	11 (46%)	7 (87%)	7 (58%)	51 (60%)
Question 7: Sensitivity and Specificity of stool- based testing	9 (32%)	5 (38%)	6 (25%)	2 (25%)	10 (83%)	32 (37%)
Question 8: Expected standard of care following stool-based tests with positive results	6 (21%)	8 (61%)	6 (25%)	2 (25%)	7 (58%)	29 (34%)
Question 9: Higher order includes: screening guidelines, contraindications and appropriate use of testing	18 (64%)	3 (23%)	16 (66%)	6 (75%)	9 (75%)	52 (61%)
Question 10: Screening interval guideline recommendations for stool-based tests	23 (82%)	N/A	6 (25%)	4 (50%)	10 (83%)	52 (61%)
Most frequently missed concept	Screening interval guideline recommendations for stool-based tests	- # of samples required for test analysis and why -Expected standard of care following stool-based tests with positive results	Method of how and when to perform stool- based testing	-Method of how and when to perform stool- based testing - of samples required for test analysis and why	-Sensitivity and Specificity of stool- based testing -Screening interval guideline recommendations for stool-based tests	Method of how and when to perform stool- based testing
Second most frequently missed concept	-Method of how and when to perform stool- based testing	-Method of how and when to perform stool- based testing -Limitations of stool- based testing	-Higher order includes: screening guidelines, contraindications and appropriate use of testing	- Higher order includes: screening guidelines, contraindications and appropriate use of testing	-Method of how and when to perform stool- based testing - Higher order includes: screening guidelines, contraindications and appropriate use of testing	-# of samples required for test analysis and why -Higher order includes: screening guidelines, contraindications and appropriate use of testing

Table: Common Misconceptions by Participant Groups.


Disclosures:
Kafayat Busari indicated no relevant financial relationships.
Marc Bernstein indicated no relevant financial relationships.
Renee Williams indicated no relevant financial relationships.


Kafayat Busari, MS, MD¹, Marc Bernstein, MD², Renee Williams, MD, FACG³. P2346 - An Educational Quality Improvement Initiative to Address Use of gFOBT, FIT and FIT-DNA by Healthcare Professionals, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.