Mail-Order Stool Testing for IBD Favorable to Patients

ORLANDO — Patients with inflammatory bowel disease (IBD) reported mostly favorable responses with the use of mail-order kits for stool sample collections, according to a survey study.

Among survey respondents with IBD who had used the mail-order option, 90.5% said they would recommend using a mail-order kit for future stool sample collection, and 83% said they would be interested in completing mail-order stool testing in the future, reported Erica Hill, RN, and Rebecca Harden, RN, of the Mayo Clinic in Jacksonville, Florida, at the Advances in Inflammatory Bowel Diseases annual meeting.

“Patients indicated an overall positive experience with this process and would choose to use mail-order stool testing over non-mail order (traditional) stool testing moving forward,” the researchers said. “The use of mail-order stool kits, especially for patients with IBD, who often need frequent stool testing, may improve testing completion, leading to appropriate and timely evaluation and treatment.”

A majority of the patients (78.5%) said their results were addressed more quickly by their healthcare team when using mail-order testing compared with an external facility, and 72% said the results were available to them faster. In both cases, more than half (57% and 55%, respectively), of respondents strongly agreed. No patients disagreed, with 22% and 28%, respectively, responding neutrally to the speed of results.

Most patients also agreed that receiving the kit in the mail removed barriers to completing testing, with two-thirds of respondents (67%) strongly agreeing and 14% agreeing. The remaining respondents were split between neutral (9%) and disagreeing/strongly disagreeing (10%).

Nearly 90% of patients said the Mayo Clinic mail-order stool collection kit was easy to use, though 9% disagreed, and 88% agreed that the mail-kit process was more convenient than going to an outside facility for stool collection, while 7% disagreed. Overall, 67% of patients strongly agreed and 24% agreed with recommending mail-kits for stool samples, while 2% were neutral and 7% disagreed.

Ali Rezaie, MD, medical director of the Cedars-Sinai Gastrointestinal Motility Program in Los Angeles, told MedPage Today that mail-order stool testing was “a viable, reliable option that improves patient experience.”

“From a clinical perspective, this workflow could significantly improve adherence to necessary testing while reducing the burden of travel and time for patients,” he noted. “Regular stool testing is vital for monitoring IBD. Mail-order kits improve convenience, adherence, and outcomes, especially for remote or mobility-limited patients, and can be integrated into routine care.”

The researchers’ decision to test the use of mail-order stool testing grew out of the need for better adherence to stool collection for clinical disease monitoring.

“In our experience, patients do not always complete, or postpone completing, stool testing, subsequently leading to a delay in diagnostics and thus treatment optimization when indicated,” the researchers wrote. “These challenges prompted development of a new stool testing workflow through mail-order stool kits.”

Patients in this study had the opportunity to include additional comments on their surveys, which largely reflected positive experiences with the mail-order option. “Receiving the kit at home was so much better, and I had to make less trips out of my house,” one patient wrote. Two others noted that outside labs have not sent the samples or did not process the sample properly, but the mail-order service “worked perfectly” and was faster and easier.

“What I liked best was that I was able to wait for a suitable stool sample at my convenience — wonderful!” wrote another patient. “I am so glad I learned how to do this as I am sure medical facilities will use this more in the future.”

Another patient noted that the stool collection kit “was vastly superior to my local lab in every way,” including ease of use, fast results, and convenience.

For this study, the researchers sent a survey to all patients with IBD at a single tertiary care center who had been sent mail-order stool kits within the previous 6 months. The survey requested demographic information and clinical characteristics, including IBD diagnosis, diagnosis date, the patient’s distance from the IBD center and external facilities (such as a commercial lab), and questions about their experience with both traditional stool testing and the mail-order stool testing kit.

Among 1,348 patients who had stool testing orders, 21% returned the survey, and 47% of these patients completed the mail-order stool testing. The researchers reported the results of the 42 patients who completed the mail-order stool testing and had complete survey data.

These respondents were mostly women (83.3%) mean age was 58.9, and mean duration of IBD was 15.9 years. Of these patients, 57.1% had Crohn’s disease, 26.2% had ulcerative colitis, 11.9% had microscopic colitis, one patient had pouchitis, and one did not know their IBD type.

The vast majority of respondents (95.2%) lived within 50 miles of a Quest Diagnostics or Labcorp facility, but most (73.8%) also lived more than 100 miles from the Mayo Clinic in Jacksonville. Only 16.7% lived within 50 miles of the clinic, and 9.5% lived 51-100 miles from it.

Rezaie noted that this study was conducted at a single institution, so generalizability of these results would need to be assessed in other settings. He also emphasized the crucial need for adequate patient education since “ensuring that patients properly collect and handle stool samples is a concern.”

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