• Paul Freeman, Kyle Couperus, Ryan Walsh, Michael J Ward, Candace D McNaughton, and Jason Bothwell.
• Department of Emergency Medicine, Landstuhl Regional Medical Center, Geb 3377, Landstuhl 66849, Germany.
• Mil Med. 2020 Sep 18; 185 (9-10): e1393-e1396.

IntroductionThere are a number of presenting Emergency Department complaints that may necessitate the testing of stool for the presence of blood. A provider-performed digital rectal examination is frequently performed solely for the collection of stool for a fecal occult blood testing (FOBT). With increased emphasis on patient autonomy and shared decision-making, it is appropriate to consider patient preferences with regard to who performs the invasive collection of stool. Our objective was to determine patient preference in regard to provider versus self-collection of stool sample for use in FOBT and identify patient demographics associated with those more likely to self-collect. Finally, we examined specimen adequacy and patient satisfaction by open-ended comment.Materials And MethodsWe conducted a 1-year, prospective, non-randomized, observational trial with a convenience sample of 100 patients. After enrollment, study participants were offered the choice of self-collection versus provider collection. Stool collection proceeded according to participant preference. Simple descriptive statistics were used to analyze the primary outcome. The secondary proportional univariate outcomes were evaluated with chi-square testing (alpha level-0.05). We used a multivariable logistic regression model to evaluate the association of independent variables with the likelihood to perform self-collection.ResultsA total of 100 patients were enrolled over 1 year, with 51% choosing to collect their own sample. Younger age was the only statistically significant predictor for self-collection (p < 0.001); furthermore, for every year of increasing age, patients were 3% less likely to choose self-collection. All self-collected samples were adequate for testing. In univariate analyses, patients younger than 35 were more likely to perform self-collection (66%) compared with those over 35 (36%). Those over 64 self-collected only 24% of the time. Neither sex nor race were associated with collection method preference.ConclusionsWhen offered the choice between self-directed or provider-performed stool sample collection, more than half of participants chose to obtain their own sample; furthermore, age was the only statistically significant predictor of preference for collection method. All patients who self-collected were able to provide an adequate sample. Our evidence suggests the offer of FOBT self-collection is a feasible method to enhance patient autonomy and improve therapeutic alliances.© Association of Military Surgeons of the United States 2020. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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