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Prev Med. 2019 Jan;118:113-121. doi: 10.1016/j.ypmed.2018.10.021. Epub 2018 Oct 24.

Population health interventions to improve colorectal cancer screening by fecal immunochemical tests: A systematic review.

Author information

1
Clinical Research & Public Health Sciences Divisions, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America; Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America; Division of Gastroenterology, University of Washington School of Medicine, Seattle, WA, United States of America. Electronic address: rissaka@fredhutch.org.
2
Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America.
3
University of California San Francisco Medical Library, University of California, San Francisco, San Francisco, CA, United States of America.
4
Department of Medicine, University of California, San Francisco, San Francisco, CA, United States of America.
5
Division of Gastroenterology, University of California, San Francisco, San Francisco, CA, United States of America; Center for Vulnerable Populations, University of California, San Francisco, San Francisco, CA, United States of America.

Abstract

Despite clear evidence that colorectal cancer (CRC) screening reduces mortality, screening, including fecal immunochemical tests (FIT), is underutilized. We conducted a systematic review to determine the evidence of efficacy of interventions to improve FIT completion that could be scaled and utilized in population health management. We systematically searched publication databases for studies evaluating provider- or system-level interventions to improve CRC screening by FIT between 1 January 1996 and 13 December 2017 without language restrictions. Twenty articles describing 25 studies were included, 23 were randomized controlled trials with 1 quasi-experimental and 1 observational study. Ten studies discussed mailed FIT outreach, 4 pre-FIT patient reminders, 3 tailored patient messages, 2 post-FIT reminders, 2 paired FIT with influenza vaccinations, 2 provider alerts and 1 study each described the use of high-quality small media and patient financial incentives. Mailed FIT outreach was consistently effective with median improvement in CRC screening of 21.5% (interquartile range (IQR) 13.6%-29.0%). FIT paired with vaccinations led to a median 15.9% (IQR 15.6%-16.3%) improvement, while pre-FIT and post-FIT reminders demonstrated modest efficacy with median 4.1% (IQR 3.6%-6.7%) and 3.1% (IQR 2.9%-3.3%) improvement in CRC screening, respectively. More than half the studies were at high or unclear risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. FIT-based CRC screening programs utilizing multilevel interventions (e.g. mailed FIT outreach, FIT paired with other preventative services, and provider alerts) have the potential to significantly increase screening participation. However, such programs must also follow-up patients with abnormal FIT results.

KEYWORDS:

Colorectal cancer; Electronic health records; Fecal immunochemical test; Interventions; Population management; Screening; Systematic review

PMID:
30367972
PMCID:
PMC6322951
[Available on 2020-01-01]
DOI:
10.1016/j.ypmed.2018.10.021

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