Behavioural interventions increase colonoscopy uptake for CRC screening

Use of behavioural interventions, specifically multicomponent and patient navigation interventions, helps increase the uptake of colonoscopy for colorectal cancer (CRC) screening, reveals a study.

“Behavioural interventions increase screening colonoscopy completion and should be adopted in clinical practice,” the investigators said. “In particular, patient navigation and multicomponent interventions are the best-studied and most effective interventions.”

The databases of PubMed, Embase, and Cochrane were searched through January 2022 for trials that examined the effect of behavioural interventions on screening colonoscopy uptake. At least two independent reviewers screened all titles, abstracts, and articles.

The investigators extracted or calculated odds ratios (OR) from the original article or from the raw data, respectively. They also conducted a random-effects meta-analysis, with subgroup analysis by type of intervention. The relative increase in screening colonoscopy completion with any behavioural intervention served as the primary outcome.

Twenty-five studies with 30 behavioural interventions met the eligibility criteria. Patient navigation (n=11) and multicomponent (n=6) were the most common interventions. Use of behavioural interventions resulted in a 54-percent improvement in colonoscopy completion relative to controls (OR, 1.54, 95 percent confidence interval [CI], 1.26‒1.88). [Am J Gastroenterol 2023;118:1829-1840]

Among the interventions assessed in multiple studies, patient navigation (OR, 1.78, 95 percent CI, 1.35‒2.34) and multicomponent interventions (OR, 1.84, 95 percent CI, 1.17‒2.89) showed the strongest impact on colonoscopy completion.

There was significant heterogeneity seen overall and by intervention type, and no evidence of publication bias was noted.

“These results provide further support for the use of behavioural interventions in CRC screening overall,” the investigators said. “Additional studies are warranted to evaluate the most effective combination of interventions.”

Patient navigation

CRC screening improved with patient navigation, particularly in the following contexts: stool testing and follow-up after abnormal stool tests, minority groups with language barriers, patients with mental illness, and low-income and underinsured populations. [Arch Intern Med 2011;171:906-912; Am J Prev Med 2017;53:363-372; J Dual Diagn 2020;16:438-446; J Gen Intern Med 2009;24:211-217]

Eleven studies that assessed patient navigation alone had substantial heterogeneity for both the backgrounds of the navigators and the format of the navigation. These navigators included lay persons, nurses, and other health workers. [J Gen Intern Med 2009;24:211-217; Arch Intern Med 2011;171:906-912; Cancer Epidemiol Biomarkers Prev 2013;22:1577-1587; J Dual Diagn 2020;16:438-446]

For the multicomponent interventions, six had been identified, of which five included patient navigation. Most of these interventions combined patient navigation with additional reminders such as letters, phone calls, and emails.

All of the interventions used led to improvements in screening colonoscopy uptake, apart from one study, wherein patients who failed to schedule their colonoscopy were automatically mailed a stool test. [Cancer 2017;123:4472-4480]

“Overall screening increased with the multicomponent intervention, but the magnitude of the effect was largely because of stool testing, and the lack of improvement for colonoscopy can be likely attributed to the competing screening option,” the investigators said.

“The positive effects of multicomponent interventions further support the use of patient navigation in combination with additional types of reminders,” they added.