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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; heterogenous 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.