A study published in JAMA Internal Medicine found that fecal blood test (FBT) outreach and patient navigation, particularly when included as part of a multicomponent intervention, were associated with increased colorectal cancer (CRC) U.S. screening rates.
Researchers conducted a systemic review of PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and ClinicalTrials.gov with key search terms including CRC and screening. They selected randomized clinical trials of U.S.-based interventions to improve CRC screening test completion in average-risk adults between January 1, 1996, and August 31, 2017.
Large meta-analysis (73 RCT's) published @JAMAInternalMed demonstrating benefit of navigation and FOBT outreach to increase screening. I will be making a ppt slide summarizing this paper. It will come in handy in many #ColorectalCancer screening talks!https://t.co/sial7nUgxC
— Doug Robertson (@DougRobertsonMD) October 18, 2018
The study included 73 trials comprising 366,766 patients at low or medium risk of bias. The following interventions were associated with increased CRC screening completion rates compared with usual care:
- FBT outreach (risk ratio [RR] = 2.26; 95% CI, 1.81-2.81; relative difference [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)
- Clinician reminders (RD=13%; 95% CI, 8%-19%)
Combinations of interventions that included clinician interventions or navigation in conjunction with FBT outreach were associated with greater screening compared with single interventions (RR=1.18; 95% CI, 1.09-1.29; RD=7%; 95% CI, 3-11). Repeated mailed FBTs with navigation were associated with increased annual FBT completion (RR=2.09; 95% CI, 1.91-2.29; RD=39%; 95% CI, 29-49). Patient navigation was not associated 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).
Evaluation of Interventions to Increase Colorectal Cancer Screening Rates in the United States https://t.co/HsS78QXsS5
— Benjamin P. Geisler (@ben_geisler) October 18, 2018
“FBT outreach should be incorporated into population-based screening programs,” the researchers concluded.
Source: JAMA Internal Medicine