Bowel Cancer Screening Counselling – OSCE guide

Bowel cancer screening tests are used to identify the presence of blood in the stool.

Blood may be present in the stool for a variety of reasons including:

• Bowel cancer
• Crohn’s disease
• Ulcerative colitis
• Gastroenteritis
• Anal fissures
• Haemorrhoids

Opening the consultation

Wash your hands and don PPE if appropriate.

Introduce yourself to the patient including your name and role.

Confirm the patient’s name and date of birth.

Explaining the screening program

In England, bowel cancer screening is recommended every two years for men and women aged between 60 and 74 and in those patients with a family history of colorectal carcinoma.

The bowel cancer screening test involves a kit that the patient uses at home.

The kit currently used in England is the faecal immunochemical test kit (known as the FIT kit). A previous generation of the kit was known as the faecal occult blood test kit (FOB kit), however, this is now being gradually phased out.

The FIT kit requires the collection of a single stool sample in a small plastic sample bottle which is then posted back to a laboratory for testing.

Example explanation

“The bowel cancer screening test for people aged 60 or over is a kit you use at home. It involves collecting a single sample of poo into a small plastic sample bottle and then posting this back to a laboratory for testing. This sample is used to check for tiny amounts of blood in your poo. It does not diagnose bowel cancer, but it’s a simple way to find out if you need further tests.”

Stool sample collection

The following steps describe how to collect a stool sample using the FIT kit:

1. Write the date on the sample bottle in biro.

2. Use a container or layers of toilet paper to catch the poo sample and don’t let the poo touch the toilet water.

3. Twist the cap to open the sample bottle.

4. Collect a sample by scraping the stick along the poo until all grooves are covered. Only a small amount of poo is required for the test.

5. Push the stick back into the sample bottle and click the cap to close it. Do not reopen the bottle after use.

6. Wash your hands

7. Put the sample bottle in the supplied return envelope.

8. Seal the envelope and post back to the laboratory.

Results

Results are posted back to the patient within 2 weeks of the sample being sent.

Normal result

A normal result means there was no blood identified in the stool sample and therefore no action is required. The patient will be invited to do another screening test in 2 years as long as they will be under 75 at that time.

Around 98 in 100 people receive a normal result.

Abnormal result

An abnormal result means that blood was identified in the stool sample and therefore the patient will be offered a colonoscopy to further assess for evidence of bowel cancer.

Advise patients that a positive test result does not necessarily mean that they have bowel cancer, it simply means that blood has been detected in the stool which may be due to a large number of conditions, many of which are easily treated.

Around 2 in 100 people receive an abnormal result.

Example explanation

“Your result should be posted to you within 2 weeks of sending off your kit.”

“A normal result means that no blood was found in your poo sample and therefore you do not need to do anything else. You’ll be invited to do another screening test in 2 years (if you’ll still be under 75 by then). Around 98 in 100 people receive a normal result.”

“An abnormal result means that blood was found in your poo sample, but this does not necessarily mean you have bowel cancer, as the blood may be due to other conditions such as piles. You’ll be offered another test called a colonoscopy to check for signs of bowel cancer. A colonoscopy involves the insertion of a thin tube with a camera at the end into your bottom.”

Closing the consultation

Summarise the key points back to the patient.

Ask the patient if they have any questions or concerns that have not been addressed.

Offer the patient some leaflets on the bowel cancer screening program and direct them to some reliable websites which they can use to gather more information (e.g. NHS.uk).

Thank the patient for their time.

Dispose of PPE appropriately and wash your hands.

References

1. National Health Service (NHS). Bowel Cancer Screening. Available from: [LINK].