Development of Clinical Practice Guideline for Colorectal Cancer Screening Using Fecal Occult Blood Test and Clinical Symptoms

Abstract

Colon and rectum cancer can be diagnosed by colonoscopy, but smaller community hospitals can not perform colonoscopy, and need to refer patients to a bigger hospital. Clinical practice guidelines in community hospitals is needed. The objective this study was to develop a clinical practice guideline which could be used in small community hospitals to correctly manage and refer the patients. It was conducted as a prospective experimental cohort study following the development of clinical practice guideline based on the symptoms and signs of cancer of colon and rectum together with the use of fecal occult blood test. The proposed guideline was tested in Yasothron Hospital, Amnatcharoen Hospital, Roi Et Hospital and com-munity hospitals in Yasothron province. Data were analyzed by using SPSS and Minitab statistical softwares. There were altogether 447 patients aged 20 years old and above who had suspected signs and symptoms fit with the inclusion criteria. The number of cases with cancer was 88 (19.69%). The clinical practice guideline was found to be practicable with 93.18% sensitivity, 68.52% specificity, 42.05% positive predictive value, and 97.62% negative predictive value. The symptom highly associated with with colorectal cancer were mucous bloody stool, palpable mass and positive fecal occult blood test. The authors recom-mended that patients with symptoms of colorectal cancer and positive fecal occult blood test together with mucous bloody stool and palpable abdominal mass for more than one week or failure to improve after symptomatic treatment should be further investigated to determine the cause of the disease.