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Interventions may improve colonoscopy rates after positive fecal blood test

Interventions, such as the implementation of patient navigators and provider reminders, may improve follow-up colonoscopy rates of asymptomatic adults with positive fecal blood test results, according to data published in Annals of Internal Medicine.

“The proportion of test-positive patients having a timely colonoscopy (for example, within 6 months) varies widely and can be lower than 50% compared with 80% to 90% in landmark [randomized controlled trials],” Kevin Selby, MD, from the division of research at Kaiser Permanente in Oakland, Calif., and colleagues wrote.

“Several patient-, provider- and system-level factors have been evaluated to improve follow-up of test-positive patients, but lack of comparative data impedes implementation of potentially effective interventions,” they added.

With limited research available on interventions that can improve fecal test follow-up, Selby and colleagues extracted data and ranked study quality from randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. They included English-language studies from the Cochrane Central Register of Controlled Trials, PubMed and Embase from database inception through June 2017 and rated overall strength of evidence for each study-type category.

In total, seven randomized and 16 nonrandomized studies were included. Of these 23 studies, 11 described patient-level interventions, such as changes to invitation, provision of results or follow-up appointments, and patient navigators; five described provider-level interventions such as reminders or performance data; and seven described system-level interventions such as automated referral, pre-colonoscopy telephone calls, patient registries and quality improvement efforts.

Analysis showed that moderate evidence supported the implementation of patient navigators and provider reminders or performance data. Additionally, low-level evidence supported system-level interventions. Seventeen studies reported the proportion of patients with a positive fecal blood test who completed follow-up colonoscopy with or without the intervention. When compared with a control population, the absolute differences were –7.4 percentage points (95% CI, –19 to 4.3) to 25 percentage points (95% CI, 14-35).

“Two promising, low-cost interventions for integrated systems are implementing provider reminder systems in the [electronic health record] and directly notifying endoscopists of all positive fecal test results,” Selby and colleagues wrote.

“Timely diagnostic colonoscopy after a positive fecal test result is a critical step on the [colorectal cancer] screening continuum ... [and] fecal testing will not be effective if positive results are not followed,” they added, later concluding that more research is needed given the critical role of the diagnostic resolution of positive test results in fecal blood-based screening. – by Savannah Demko

Disclosures: Selby reports receiving grants from the Swiss Cancer Research Foundation. Please see the study for all other authors’ relevant financial disclosures.