Michael Dougherty|Alison T. Brenner|Seth D. Crockett|Shivani Gupta|Stephanie B. Wheeler|Manny Coker?Schwimmer|Laura Cubillos|Teri L. Malo|Daniel Reuland
Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States
University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|Icahn School of Medicine at Mount Sinai|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill|University of North Carolina at Chapel Hill
h3importanceh3 colorectal cancer screening crc recommended major us medical organizations remains underused h3objectiveh3 identify interventions associated increasing crc screening rates effect sizes h3data sourcesh3 pubmed cumulative index nursing allied health literature cochrane library clinicaltrialsgov searched january 1 1996 august 31 2017 key search terms includedicolorectal canceriandiscreeningi h3study selectionh3 randomized clinical trials usbased interventions clinical settings designed improve crc screening test completion averagerisk adults h3data extraction synthesish3 least 2 investigators independently extracted data appraised studys risk bias sufficient data available randomeffects metaanalysis used obtain either pooled risk ratio rr risk difference rd screening completion type intervention h3main outcomes measuresh3 main outcome completion crc screening examination included interventions increase completion 1 initial crc screening recommended modality 2 colonoscopy abnormal initial screening test result 3 continued rounds annual fecal blood tests fbts h3resultsh3 main review included 73 randomized clinical trials comprising 366 766 patients low medium risk bias interventions associated increased crc screening completion rates compared usual care included fbt outreach rr 226 95 ci 181281 rd 22 95 ci 1727 patient navigation rr 201 95 ci 164246 rd 18 95 ci 1323 patient education rr 120 95 ci 106136 rd 4 95 ci 16 patient reminders rr 120 95 ci 102141 rd 3 95 ci 05 clinician interventions academic detailing rd 10 95 ci 317 clinician reminders rd 13 95 ci 819 combinations interventions clinician interventions navigation added fbt outreach associated greater increases single components rr 118 95 ci 109129 rd 7 95 ci 311 repeated mailed fbts navigation associated increased annual fbt completion rr 209 95 ci 191229 rd 39 95 ci 2949 patient navigation associated colonoscopy completion initial abnormal screening test result rr 121 95 ci 092160 rd 14 95 ci 029 h3conclusions relevanceh3 fecal blood test outreach patient navigation particularly context multicomponent interventions associated increased crc screening rates us trials fecal blood test outreach incorporated populationbased screening programs research needed interventions increase adherence continued fbts followup abnormal initial screening test results costeffectiveness implementation barriers intensive interventions navigation