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Bowel Screening

The instructions for using the FOBt kit

People are sent a Faecal Occult Blood test (FOBt) kit one week after the letter inviting them to take part in screening. The kit comes with full instructions, cardboard sticks with which to collect the stool samples and a freepost envelope in which to return the kit for analysis at the programme “hub” laboratory (see 'The pilot and the programme since then').

 

Andrea Giles, specialist screening practitioner, talks about the Faecal Occult Blood test.

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Can you tell me about the test kit that is used for screening for bowel cancer?

You will be invited to participate in the bowel cancer screening programme if you are aged between 60 and 69 and registered with a GP. One week after your initial invitation letter you will be sent a Faecal Occult Blood testing kit, or an FOB for short.

Along with the kit comes a cardboard stick to collect samples with, and an instruction leaflet telling you how to take your sample.

The FOB kit comes with your NHS number printed on the front, it also has space for you to write the date that you take each sample. When you are ready to take your first sample of your bowel motion, you need to lift up flap one and underneath are windows one and two, where you have to smear two different samples of the one motion onto the card. 

To obtain your sample you may want to use a clean container to catch your bowel motion, or use folded pieces of tissue paper to collect your bowel motion on wiping your bottom. Once you have obtained your sample of bowel motion you need to open flap one on your FOB kit and take a clean stick and take a sample of bowel motion and smear this onto window one on the card. Once that's done, discard that stick and get a clean stick to take another sample from the same bowel motion, but a different area, and smear this onto window two. Discard that stick. The sample is now complete, and you need to fold the flap down and write the date that you took the sample on the front.

You need to collect samples from three different bowel motions. The bowel motions don't have to be following one another. They could be on three separate days, for instance, Monday, Wednesday and Friday, but once opened the kit does need to be completed and returned within 14 days.

While you are taking your samples to store the test kit, you can keep it in a plastic bag, out of direct sunlight.

Several people told us about their experiences of taking part in screening:

  • Six tiny samples from three separate bowel motions are collected (2 from each bowel movement).
  • Bowel motions must be caught before they reach the water or touch the toilet bowl.
  • There are three flaps on the test kit, each with two 'windows' underneath. Samples are smeared onto the test kit windows (these used to be small circles but are now small rectangles) with the cardboard sticks provided.
  • The kit must be returned to the hub for testing within 14 days of the first sample being taken.
 

Shows the type of test card he used and explains that you must not open the back of it.

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Age at interview: 63
Sex: Male
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Could you just explain to people exactly what you do day by day?

This is a sample of the card that I had on the first time. Basically, there, there's three flaps as you can see one, two, three. The first day hold the flap up, there's two circles there, all you do is put the sample onto the two circles, you needn't put loads of it, just enough to fill the circle. Put the flap down and then that folds into the bottom underneath the thing. Then the next day lift the flap up again, do exactly the same, tuck it down and in and then it goes away in a, like a an aluminium foil envelope so that it's completely sealed. Don't open the back because then that ruins everything. It says 'do not open' on it but from what I've been told a lot of people do. But it's so easy, day one, day two, and then day three. Clip it back down, into the envelope, into the post and every time I've done it the results have been less than 72 hours.

 

He smeared two samples of a stool onto the test card on three different occasions.

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Age at interview: 65
Sex: Male
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On the first day I sat on the toilet and as soon as I passed my bowel [motion] I wiped myself with a piece of toilet paper, took some of my stool, scraped with the scraper that was provided and had to dab it on that first screen. And then at the end of my bowel motion I took a second sample and placed it on that one. And then for the next two days after I had to do exactly the same again until I'd finished the third and then I had to make sure it was clicked under, put it back into the, the aluminium type envelope and post it back free of charge.

 

Explains that if you had frequent bowel motions you could do the test on three different...

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Age at interview: 59
Sex: Male
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In about 2001 I first received the test kit through the post. It's really a simple kit with three individual little envelopes and it comes with three sticks and basically what you do you need to take a sample of your motion from a different part each time, not necessarily every day but you can do it from a different motion every time. So possibly I mean anybody who could, you know probably goes to the loo a lot, which I do, could do the test kit really in a whole day [laughs] which I normally did. But it is quite simple and straightforward and then obviously you pop the little lid on the envelope down and then once you've completed the three test kits, the three envelopes, you pop it in the post and that's it really. And if, you know if you get the all clear they'll send you the information back telling you that the test was clear or it's not obviously you'll receive information to advise you how to proceed further.

So the test kit comes through the post, can you explain in detail exactly what you have to do please?

Yes you do, you take your test kit and you take a smear of your motion, pop it into the little, the little envelopes. Each, each motion, each part of the motion has to be taken from a separate part. You take your stick and you pop your little bit of smear of your motion in there and then you pop your little envelope down and seal it up. Finally the next, the next time you do a motion again you need to do a separate part of your motion again and also smear with your little stick onto your envelope and pop your little flap down. Finally on the third part you need to do the same again but it has to be from a different part of your motion.

 

Missing a day did not matter as long as stool samples were taken on three different occasions.

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Age at interview: 65
Sex: Male
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Then you had the test kit that came through the post a week later. That came with an information leaflet too. Can you say something about that information leaflet?

Well only as in much as it fully explained precisely what we'd got to do, how to go about it, how it was necessary. It was very straightforward, as simple as that. I knew that I'd got to take samples from my motions, on three separate occasions.

Was it clear to you that you had 14 days to do it in?

Yes, I remember thinking well sometimes I have a bowel movement once a day, twice a day, you might miss a couple of days, but I thought well that's not a problem if I've got 14 days, I'm not going to worry about it.

Particularly if, and there's no easy way of saying this, but if one has a particularly loose bowel movement, it's not the easiest, or most pleasant thing to do. So that one had got 14 days and that didn't, wouldn't have been a worry. So no, it wasn't a problem at all. It was very much something that I did, I didn't tell my wife, I don't know why particularly, she's very supportive, always has been, but I didn't. I did the one sample, put it away, did the second, then the third and this was all done over a period of 48 hours I think, in my instance.

Almost all the people we talked to found the instructions that came with the test kit very clear, saying they were 'very precise' or 'told you exactly what to do'. One man said they were 'spot on' and that he could not fault them in any way.

 

The Faecal Occult Blood test (FOBt) kit instructions were very clear.

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Age at interview: 58
Sex: Female
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Can you remember your feelings about the information that came with the kit?

Well yeah I thought it was very straightforward, I read it through and made sure I'd got everything prepared. It told you what to do, it told you exactly what to do, what to do first and how to set it up and everything and I did all that, and yes pretty straight forward, when I did it.

A few people thought the instructions were a little 'ambiguous' or could be 'misunderstood'. Some were not sure how much of their stool (faeces) they had to smear onto the small windows on the card. One man thought that it might be easier if the windows (the small circles or rectangles) were a bit deeper.   

One woman wrongly thought she had to use samples from alternate days, and another woman thought she had to use samples on consecutive days (see 'Why some were reluctant or did not take part'). In fact, samples can be taken at any time within 14 days, as long as three different stools are used.

 

She wrongly thought the samples from her bowel motion had to be put on the card on alternate days.

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Age at interview: 70
Sex: Female
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What did you make of the information leaflet that came with the test kit? It tells you how to do it. 

It was, yeah it made sense, so yes so it was okay, I didn't have any real problem with it, no, the instructions were fairly clear and yeah no problem, no problem at all.

Was it clear to you how many days you had to do it after you'd opened it?

It had to be done; yes I did mine on alternate days, they couldn't be done on three consecutive days could they? There had to be a time in between each sample.

I think they can be on consecutive days.

Can they, oh I thought'

It had to be within fourteen days of taking it.

Yes, I did mine on alternate days anyway, you know I thought well.

And you thought it had to be alternate days.

I thought it had to be alternate days, I thought there had to be a spell in between each one. 

So you thought there had to be more than; at least a day in between each sample?

I thought there had to be at least 24 hours between each, each sample taken yes, yes. Yes I don't think, I wondered if I panicked into reading it wrongly, do you know what I mean when you read things wrongly? But no I was, I was fairly certain that it couldn't be consecutive days, there had to be a spell in between.

One woman felt confused when she opened the test kit but when she looked at the instructions everything became clear.

 

Suggests that you read the instructions before opening the test kit.

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Age at interview: 70
Sex: Female
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What did you think of the little leaflet with the information, with the test kit?

It was, it was very good and as I say I just made my own mind up how I was going to do it but it was very good, it told you what to do and everything as regards that. And when you see the, when you see the, the kit before you read the book and you just open it and you see the kit you think, 'Oh my God'. And you, it's difficult, but reading the booklet after, and going through, and then you know what you've got to do then, then everything comes into perspective. But just opening up and seeing them whatsername you don't know what to expect [laughs].

How, would you have made the information different in any way?

Well no, not really, because I mean by rights you should read the leaflet before you look at the kit.

Oh I see.

But I just took it out, looked at it and I thought, 'Oh' [laughs].

During the first part of the pilot programme people were asked to exclude certain foods from their diet while they were collecting their stool samples. One woman, for example, was asked to repeat the test taking care to exclude red meat and certain vegetables.

 

She took part in the pilot programme. It required some dietary restrictions because it was...

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Age at interview: 70
Sex: Female
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I was invited to take part in the test in 2001 and it came back clear. I was very pleased about that and then I had another one in 2004 which wasn't clear and they sent me a letter to say that I should do it again and to adjust my diet and not to eat red meat and colourful vegetables like broccoli and tomatoes and vitamin C supplements. And the result from that then was clear, but they just wanted to be sure because some of these things can colour the motions or do something and it makes it look like there's problems. 

Diet does not affect the test and the current NHS bowel cancer screening programme requires no dietary restrictions.


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Last reviewed May 2016.

Last updated May 2016.

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