Dougherty MK, et al. - Considering the recommendation for colorectal cancer screening (CRC) by all major US medical organizations, researchers assessed interventions intended to increase CRC screening rates and their effect sizes. In this systematic review and meta-analysis, patient navigation and fecal test outreach, particularly with multicomponent interventions, were linked with increased CRC screening rates. Hence, they recommend the incorporation of fecal blood test outreach into population-based screening programs.

Methods

• From January 1, 1996 to August 31, 2017, researchers searched PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and ClinicalTrials.gov using “colorectal cancer” and “screening” as the key search terms.
• They selected randomized clinical trials of US-based interventions in clinical settings designed to improve CRC screening test completion in average-risk adults.
• Data extraction and appraisal of each study’s risk of bias were performed by at least 2 investigators independently.
• They used random-effects meta-analysis to obtain either a pooled risk ratio (RR) or risk difference (RD) for screening completion for each type of intervention, when enough data were available.
• Completion of CRC screening was assessed as the main outcome.
• Examination included interventions to increase completion of initial CRC screening by any recommended modality, colonoscopy after an abnormal initial screening test result, and continued rounds of annual fecal blood tests (FBTs).

Results

• Researchers reviewed 73 randomized clinical trials comprising 366,766 patients at low or medium risk of bias.
• Compared with usual care, increased CRC screening completion rates were noted with interventions such as FBT outreach (RR, 2.26; 95% CI, 1.81-2.81; RD, 22%; 95% CI, 17%-27%), patient navigation (RR, 2.01; 95% CI, 1.64-2.46; RD, 18%; 95% CI, 13%-23%), patient education (RR, 1.20; 95% CI, 1.06-1.36; RD, 4%; 95% CI, 1%-6%), patient reminders (RR, 1.20; 95% CI, 1.02-1.41; RD, 3%; 95% CI, 0%-5%), clinician interventions of academic detailing (RD, 10%; 95% CI, 3%-17%), and clinician reminders (RD, 13%; 95% CI, 8%-19%).
• Greater increase was noted with combinations of interventions (clinician interventions or navigation added to FBT outreach) vs single components (RR, 1.18; 95% CI, 1.09-1.29; RD, 7%; 95% CI, 3%-11%).
• Increased annual FBT completion were noted in correlation with repeated mailed FBTs with navigation (RR, 2.09; 95% CI, 1.91-2.29; RD, 39%; 95% CI, 29%-49%).
• They noted no association of patient navigation with colonoscopy completion after an initial abnormal screening test result (RR, 1.21; 95% CI, 0.92-1.60; RD, 14%; 95% CI, 0%-29%).