Columbia Gorge Community College

When I was a child, my father worked for the Naval Ordinance Plant in Forest Park, Illinois as an electrical engineer. He traveled frequently, flying out of Midway Airport or taking the train. For short trips during the winter, the train was almost as fast and more reliable. He traveled to Seattle, and these trips involved two or more stops to refuel. After O’Hare Airport opened, DC-6 and Lockheed Tri-Star planes began to support nonstop flights to Seattle with significant time savings. When 707s and DC-8s arrived, the long flights became much shorter. My family would take our father to the airport to say goodbye and head to the observation deck to watch his plane take off. Plane delays because of “mechanical” problems were more often than not issues with mechanical gyros. These delays were substantial, and he would join us on the observation deck to pass the time. Because of weather conditions on these flights, safe, efficient travel depended heavily on the aircraft guidance system. My first flight on an airplane was to Seattle in 1970 during a college Christmas break. It was a red eye on a 747 repositioning flight with about as many crew as passengers on board. Being a math and physics major, I thought at the time it would be wonderful to play a part in the design of this type of plane.

Colorectal cancer (CRC) is the third leading cause of cancer death in the United States, yet 1 in 3 Americans have never been screened for CRC. Annual screening using fecal immunochemical tests (FITs) is often a preferred modality in populations experiencing CRC screening disparities. Although multiple studies evaluate the clinical effectiveness of FITs, few studies assess patient preferences toward kit characteristics. We conducted this community-led study to assess patient preferences for FIT characteristics and to use study findings in concert with clinical effectiveness data to inform regional FIT selection. We collaborated with local health system leaders to identify FITs and recruit age eligible (50 to 75 years), English or Spanish speaking community members. Participants completed up to 6 FITs and associated questionnaires and were invited to participate in a follow-up focus group. We used a sequential explanatory mixed-methods design to assess participant preferences and rank FIT kits. First, we used quantitative data from user testing to measure acceptability, ease of completion, and specimen adequacy through a descriptive analysis of 1) fixed response questionnaire items on participant attitudes toward and experiences with FIT kits, and 2) a clinical assessment of adherence to directions regarding collection, packaging, and return of specimens. Second, we analyzed qualitative data from focus groups to refine FIT rankings and gain deeper insight into the pros and cons associated with each tested kit. Seventy-six FITs were completed by 18 participants (Range, 3 to 6 kits per participant). Over half (56%, n = 10) of the participants were Hispanic and 50% were female (n = 9). Thirteen participants attended 1 of 3 focus groups. Participants preferred FITs that were single sample, used a probe and vial for sample collection, and had simple, large-font instructions with colorful pictures. Participants reported challenges using paper to catch samples, had difficulty labeling tests, and emphasized the importance of having care team members provide verbal instructions on test completion and follow-up support for patients with abnormal results. FIT rankings from most to least preferred were OC-Light, Hemosure iFOB Test, InSure FIT, QuickVue, OneStep+, and Hemoccult ICT. FIT characteristics influenced patient's perceptions of test acceptability and feasibility. Health system leaders, payers, and clinicians should select FITs that are both clinically effective and incorporate patient preferred test characteristics. Consideration of patient preferences may facilitate FIT return, especially in populations at higher risk for experiencing CRC screening disparities.

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