Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide.
However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results.
Dr Kevin Selby and colleagues evaluated interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test.
The team identified English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through 2017.
Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results.
There were 2 reviewers that independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type.
|17 studies reported the proportion of test-positive patients who completed colonoscopy |
|Annals of Internal Medicine|
The researchers identified 23 studies eligible for analysis, including 7 randomized and 16 nonrandomized studies.
The team found that 3 were at low risk of bias.
The researchers noted that 11 studies described patient-level interventions, 5 provider-level interventions, and 7 system-level interventions.
Moderate evidence supported patient navigators and provider reminders or performance data.
Evidence for system-level interventions was low.
The research team found that 17 studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of −7 percentage points to 25 percentage points.
Dr Selby's team concludes, "Patient navigators and giving providers reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results."
"Current evidence about useful system-level interventions is scant and insufficient."