Evaluation of intervention strategies to improve follow-up after FIT/FOBT tests: A systematic review and meta-analysis.

Abstract

10549 Background: Colorectal cancer (CRC) is the third most common cancer worldwide, with the majority of patients diagnosed at advanced stages. Early detection through screenings has been shown to improve morbidity and mortality. However, follow-up after Fecal Immunochemical Test (FIT) / Fecal Occult Blood Test (FOBT) screenings remains low, with 30%-61% compliance to colonoscopy screening and 28-49% compliance to repeat FIT/FOBT surveillance. Our study aims to evaluate 1) interventions targeting colonoscopy completion post-positive FIT/FOBT and improving adherence to follow-up after negative FIT/FOBT, and 2) the rate of colonoscopy completion post-positive FIT/FOBT and the rate of repeat FIT/FOBT adherence after a negative result. Methods: We searched MEDLINE, Embase, and Cochrane from inception to December 20, 2025, to identify cohort studies or randomized controlled trials (RCTs) comparing interventions to improve follow-up colonoscopy after positive FIT/FOBT and repeat FIT/FOBT after negative FIT/FOBT. We computed risk ratios (RR) with accompanying 95% confidence Intervals (CIs) for each study and pooled the results using a random-effects meta-analysis. Results: Twenty-seven studies involving 30,974 patients were included. 19 studies (11,905 patients) evaluated interventions to improve colonoscopy completion after a positive FIT/FOBT. Patient-level interventions (RR 1.30, 95% CI 1.17–1.44, n=13) and system-level interventions (RR 1.45, 95% CI 1.20–1.77, n=6) significantly increased colonoscopy completion. Patient navigation (RR 1.28, 95% CI 1.15–1.41), patient reminders (RR 1.32, 95% CI 1.04–1.67), and provider reminders (RR 1.45, 95% CI 1.16-1.83) were effective. Patient reminders via messaging (RR 1.55, 95% CI 1.31-1.83) were more effective than calling (RR 1.10, 95% CI 0.91-1.33, p=0.0083). Follow-up colonoscopy increased from 45.8% in controls to 65.9% after interventions. 8 studies (19,069 patients) assessed repeat FIT/FOBT adherence after a negative result. Patient navigation (RR 1.89, 95% CI 1.36–2.63) and patient reminders (RR 1.31, 95% CI 1.01–1.71) significantly improved adherence, increasing rates from 46.0% in controls to 66.5% after interventions. Based on our findings, we developed a protocol to improve colonoscopy completion post-positive FIT/FOBT and adherence to follow-up after negative FIT/FOBT. Conclusions: Patient-level and system-level interventions improve adherence to follow-up colonoscopy post FIT/FOBT. Patient navigation and patient reminders increase completion of follow-up colonoscopy and adherence to follow-up FIT/FOBT. Healthcare systems should adopt patient-level and system-level interventions to enhance compliance with follow-up after initial FIT/FOBT testing.