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Cited by 362Colorectal Cancer Screening and DetectionGlobal Cancer Incidence and ScreeningColorectal Cancer Surgical Treatments

Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States: A Systematic Review and Meta-analysis

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Dougherty, Michael K., Brenner, Alison T., Crockett, Seth D., Gupta, Shivani, Wheeler, Stephanie B., Coker-Schwimmer, Manny, Cubillos, Laura, Malo, Teri +1 more·2018·JAMA Internal Medicine
DOI 10.1001/jamainternmed.2018.4637PMC PMC6583619
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Abstract

Importance: Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused. Objective: To identify interventions associated with increasing CRC screening rates and their effect sizes. Data Sources: PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and ClinicalTrials.gov were searched from January 1, 1996, to August 31, 2017. Key search terms included colorectal cancer and screening. Study Selection: Randomized clinical trials of US-based interventions in clinical settings designed to improve CRC screening test completion in average-risk adults. Data Extraction and Synthesis: At least 2 investigators independently extracted data and appraised each study's risk of bias. Where sufficient data were available, random-effects meta-analysis was used to obtain either a pooled risk ratio (RR) or risk difference (RD) for screening completion for each type of intervention. Main Outcomes and Measures: The main outcome was completion of CRC screening. Examination included interventions to increase completion of (1) initial CRC screening by any recommended modality, (2) colonoscopy after an abnormal initial screening test result, and (3) continued rounds of annual fecal blood tests (FBTs). Results: The main review included 73 randomized clinical trials comprising 366 766 patients at low or medium risk of bias. Interventions that were associated with increased CRC screening completion rates compared with usual care included FBT outreach (RR, 2.26; 95% CI, 1.81-2.81; 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%), and clinician reminders (RD, 13%; 95% CI, 8%-19%). Combinations of interventions (clinician interventions or navigation added to FBT outreach) were associated with greater increases than single components (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%). Conclusions and Relevance: Fecal blood test outreach and patient navigation, particularly in the context of multicomponent interventions, were associated with increased CRC screening rates in US trials. Fecal blood test outreach should be incorporated into population-based screening programs. More research is needed on interventions to increase adherence to continued FBTs, follow-up of abnormal initial screening test results, and cost-effectiveness and other implementation barriers for more intensive interventions, such as navigation.

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Cited by

Sorted by citations

Authors
Dougherty, M. K., Brenner, A. T., Crockett, S. D., Gupta, S., Wheeler, S. B., Coker-Schwimmer, M., Cubillos, L., Malo, T., & Reuland, D. S.
Affiliations
  • University of North Carolina at Chapel Hill (US)
  • Icahn School of Medicine at Mount Sinai (US)
Corresponding author
Reuland, Daniel S.
ORCID
Venue
JAMA Internal Medicine
Publisher
American Medical Association (AMA)
Published
2018-12-01
Volume
178
Issue
12
Pages
1645
ISSN
2168-6106 (ISSN-L)
DOI
10.1001/jamainternmed.2018.4637
PMC
PMC6583619
OpenAlex
W2897894473
Cited by
362
References
3
Citations by year
2026: 53 · 2025: 44 · 2024: 51 · 2023: 58 · 2022: 39 · 2021: 51 · 2020: 44 · 2019: 19 · 2018: 1
FWCI
3.00
Type
journal article
Language
en
Open access
Locations
  • JAMA Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (KL2TR001109)
  • National Cancer Institute (P30CA016086)
  • National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007634)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Screening and Detection
  • Health Sciences › Medicine › Oncology › Global Cancer Incidence and Screening
  • Health Sciences › Medicine › Oncology › Colorectal Cancer Surgical Treatments
Keywords
colorectal cancer screening, screening completion, screening interventions, patient navigation, patient education, patient reminders, academic detailing, colonoscopy, effect size, risk of bias, quality improvement, health disparities, health equity, low-income populations, rural population, racial and ethnic minorities
MeSH terms
Humans, United States, Colorectal Neoplasms, Early Detection of Cancer

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