Stool-based colorectal cancer screening is a two-step process: a positive fecal immunochemical test or fecal occult blood test must be followed by a colonoscopy. Yet many patients never complete that follow-up. A new meta-analysis in JAMA Internal Medicine pooled 21 interventional studies involving nearly 20,000 patients to see which strategies actually improve adherence.
The results show that patient navigation and patient or clinician reminders all boosted colonoscopy completion, with pooled rates of 69.1% in intervention groups versus 47.8% in controls. Automated referral to a GI consult had the largest relative effect (RR 1.68), while patient navigation achieved the highest absolute completion rate at 72.5%. Patient-level interventions performed slightly better overall than system-level ones (71.1% vs 65.4%).
Despite these gains, completion rates still lagged behind the 80% target set by the U.S. Multi-Society Task Force on CRC. The accompanying editorial argues that doing something is better than nothing, and that clinics should pick an approach suited to their own constraints. The researchers note that further work is needed on multicomponent strategies and cost-effectiveness, and the analysis was limited by study heterogeneity and few direct comparisons between interventions.