FECAL CALPROTECTIN TESTING: AN INVESTIGATION OF PATIENT COMPLIANCE AND PERCEPTIONS. (22nd January 2022) - Perry, Courtney
Abstract: INTRODUCTION: Inflammatory Bowel Disease (IBD) is a lifelong illness requiring close management. Prompt disease recognition and tight control of disease activity reduces disease morbidity and improves outcomes 1 . Endoscopy with histologic examination is the gold standard for assessing "deep remission 2 ." However, frequent endoscopic evaluation is not always feasible or cost effective. Fecal Calprotectin (FC), a paradigm shifting biomarker, is both sensitive and specific for histologic inflammation in IBD 2 . However, the efficacy of this test rests on patient's willingness to handle and submit stool samples. Studies investigating FC non-compliance are scarce, and all have been performed outside the US. Thus, we elected to survey our patients to assess barriers to FC compliance. METHODS: We recruited 104 participants with Crohn's disease (CD) or Ulcerative Colitis (UC) from our IBD clinic to participate in a prospective cross-sectional study. We administered an author-designed mixed-method questionnaire consisting of 23 questions with multiple choice, yes/no, rank order, and open-ended questions. The primary outcomes of interest were risk factors for non-compliance. Patient compliance over a two year period (1/2018 through 1/2020) was self-reported and verified retrospectively by the authors. Responses to questions were grouped according to level of FC compliance (<50% compliance, 50-99% compliance, 100% compliant). Categorical variables were analyzed using chi2 and Fishers exact test. Continuous variables were analyzed using Mann-Whitney and Kruskal-Wallis tests. RESULTS: Among the 104 participants surveyed, 56 were always compliant with FC testing (53.8%).The remaining 48 participants fell on a spectrum of compliance, with most participants completing between 50-75% of fecal calprotectin tests over the study period (n=29, 60.4%). Only 8 participants were "never" compliant. Physician determined compliance was significantly associated with participant completion (p=0.001) . Number of "no-show" clinic visits was associated with FC compliance (p=0.013 ). Participants who reported FC testing embarrassing were significantly less likely to be compliant (p=0.037 ), and were less likely to report that they found stool testing important (p=0.020 ). In the qualitative portion of the survey, recurring frustrations included inconvenience of testing, embarrassment associated with stool submission, and lack of streamlined sample submission. CONCLUSION: Fecal calprotectin is a valuable tool for IBD monitoring, but testing can be cumbersome and usefulness is limited by compliance. Embarrassment was a significant compliance barrier, suggesting that improved education and protocols for laboratory discretion would improve FC submission and patient experience.