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TOPLINE:

Patient navigation and mailed fecal immunochemical test (FIT) outreach were the most effective strategies for increasing uptake of colorectal cancer (CRC) screening, with increases of 58% and 36%, respectively, compared with usual care. Mailed FIT outreach excelled in populations with screening rates below 30%, whereas multimedia interventions showed the strongest performance in higher-uptake settings.

METHODOLOGY:

• Various screening methods are effective in identifying individuals at risk for CRC, but their global uptake is low, especially in underserved populations; barriers to screening highlight the need for targeted interventions to improve participation.
• Researchers conducted a systematic review and network meta-analysis of 76 randomized clinical trials to compare the effectiveness of eight uptake interventions for CRC screening.
• The trials compared at least one intervention against usual care or another active intervention, and 400,638 adults typically aged 50-75 years, who were eligible for CRC screening were included in the analysis.
• The eight intervention strategies were as follows:
  • Patient navigation, which offered personalized support to address educational, logistical, and follow-up barriers.
  • Mailed FIT outreach, involving the proactive distribution of FIT kits to patients’ homes with instructions.
  • Educational multimedia, utilizing digital and audiovisual tools to inform and motivate participation in screening.
  • Reminder-only interventions, providing nonpersonalized prompts to remind individuals about screening.
  • Choice-based outreach, offering multiple screening options for individuals to select.
  • Colonoscopy outreach, aimed at promoting the completion of colonoscopy procedures.
  • Multistep strategies, which integrated sequential outreach approaches such as prenotifications, mailed kits, and follow-up reminders.
  • Usual care, representing standard practice without structured outreach initiatives.
• Studies were stratified by publication era, baseline screening uptake, and geographic setting. A frequentist network meta-analysis with random-effects models was employed, and rankograms were used to assess intervention rankings.

TAKEAWAY:

• Patient navigation demonstrated the highest overall effectiveness compared with usual care for increasing uptake of CRC screening (risk ratio [RR], 1.58; 95% CI, 1.23-2.02), followed by mailed FIT outreach (RR, 1.36; 95% CI, 1.07-1.74). Both interventions showed the highest effectiveness during the 2008-2021 era.
• Mailed FIT outreach was significantly more effective than colonoscopy outreach (RR, 1.35; 95% CI, 1.11-1.63), and patient navigation outperformed reminder-only interventions (RR, 1.48; 95% CI, 1.14-1.94).
• In populations with baseline screening uptake below 30%, mailed FIT outreach showed the strongest effect (RR, 3.12; 95% CI, 1.70-5.71), followed by patient navigation (RR, 1.72; 95% CI, 1.13-2.60), whereas educational multimedia showed the highest effectiveness in populations with uptake of 30% or more (RR, 1.22; 95% CI, 1.04-1.44).
• Patient navigation and mailed FIT outreach showed the highest combined probabilities of ranking first or second, and educational multimedia had the highest probability of ranking third or fourth. In the US context, mailed FIT outreach was the most effective strategy for boosting screening uptake, ranking as the top intervention (RR, 1.86; 95% CI, 1.33-2.60).

IN PRACTICE:

“[The study] findings support the tailored deployment of CRC screening interventions based on population characteristics and programmatic goals. Patient navigation remains a highly effective strategy, particularly in resource-limited settings, though its labor-intensive nature may limit scalability. Mailed FIT outreach offers a cost-effective and scalable solution, particularly suited for large-scale initiatives in low-uptake populations,” the authors of the study wrote.

SOURCE:

The study was led by Daryl Ramai, MD, University of Utah, Salt Lake City, and Chun-Wei Pan, MD, University of Massachusetts Chan Medical School, Worcester, Massachusetts. It was published online in Gastroenterology.

LIMITATIONS:

The study did not evaluate the effectiveness of combined intervention strategies in improving screening uptake or the role of financial incentives. Mailed FIT may fail to detect cancers that bleed intermittently, and a negative result does not rule out CRC; therefore, clinical judgment remains essential in conjunction with the test results. Most included trials measured short-term screening completion rather than long-term adherence.

DISCLOSURES:

The authors reported having no funding sources for the study. One author disclosed serving as a consultant and receiving research support from various pharmaceutical and medical device companies, with an ownership interest in Satisfai Health. Another author disclosed serving as a consultant for Olympus Corporation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.