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Showing content from https://pubmed.ncbi.nlm.nih.gov/29049756/ below:

Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review

Review

. 2017 Oct 17;167(8):565-575. doi: 10.7326/M17-1361. Epub 2017 Oct 10. Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review

Affiliations

Affiliation

¹ From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California.

PMID: 29049756
PMCID: PMC6178946
DOI: 10.7326/M17-1361

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Review

Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review

Kevin Selby et al. Ann Intern Med. 2017.

. 2017 Oct 17;167(8):565-575. doi: 10.7326/M17-1361. Epub 2017 Oct 10. Affiliation

¹ From Kaiser Permanente Division of Research, Oakland, California; University of Lausanne, Lausanne, Switzerland; University of California at San Francisco, San Francisco, California; Bern University Hospital, Bern, Switzerland; Kaiser Permanente Medical Center, Walnut Creek, California; University of Pennsylvania, Philadelphia, Pennsylvania; Memorial Sloan Kettering Cancer Center, New York, New York; and Kaiser Permanente, Pasadena, California.

PMID: 29049756
PMCID: PMC6178946
DOI: 10.7326/M17-1361

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Abstract

Background: 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.

Purpose: To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical).

Data sources: English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017.

Study selection: Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results.

Data extraction: Two reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type.

Data synthesis: Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of -7.4 percentage points (95% CI, -19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points).

Limitation: More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis.

Conclusion: 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.

Primary funding source: National Cancer Institute. (PROSPERO: CRD42016048286).

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Conflict of interest statement

Disclosures: Dr. Selby reports grants from the National Cancer Institute and the Swiss Cancer Research Foundation and funding from the Swiss National Science Foundation during the conduct of the study. Dr. Levin reports grants from the National Institutes of Health during the conduct of the study. Dr. Doubeni reports being a member of the U.S. Preventive Services Task Force during the conduct of the study and personal fees from UpToDate outside the submitted work. Dr. Jensen reports grants from the National Cancer Institute during the conduct of the study. Dr. Corley reports grants from the National Cancer Institute during the conduct of the study. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M171361 .

Figures
Figure 1.

Flow chart of study selection…

Figure 1.

Flow chart of study selection for interventions to improve follow-up of positive fecal…

Figure 1.

Flow chart of study selection for interventions to improve follow-up of positive fecal blood tests for colorectal cancer screening. CENTRAL = Cochrane Central Register of Controlled Trials.

Figure 2.

Overview of included studies of…

Figure 2.

Overview of included studies of interventions to improve follow-up of positive fecal blood…

Figure 2.

Overview of included studies of interventions to improve follow-up of positive fecal blood tests for colorectal cancer screening, by intervention level and category. HR = hazard ratio; NA = not applicable; NR = not reported. n/a: not available; UK: United Kingdom; USA: United States of America *Studies with separate reporting of more than one comparison are listed as A, B, C with further details in Table 1 †Risk of bias for individual study according to Agency for Healthcare Research and Quality and GRADE criteria (36,37), details in Appendix B ‖Follow-up interval given only when specifically provided by authors, otherwise marked unspecified ^#Adjusted absolute change, as reported by study authors