• Kevin Selby, Christine Baumgartner, Theodore R Levin, Chyke A Doubeni, Ann G Zauber, Joanne Schottinger, Christopher D Jensen, Jeffrey K Lee, and Douglas A Corley.
• 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.
• Ann. Intern. Med. 2017 Oct 17; 167 (8): 565575565-575.

BackgroundFecal 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.PurposeTo evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical).Data SourcesEnglish-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017.Study SelectionRandomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results.Data ExtractionTwo reviewers independently extracted data and ranked study quality; 2 rated overall strength of evidence for each category of study type.Data SynthesisTwenty-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).LimitationMore than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis.ConclusionPatient 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 SourceNational Cancer Institute. (PROSPERO: CRD42016048286).

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