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Patient navigators and provider reminders may improve follow-up after positive faecal blood test

Tue, 10/10/2017 - 13:26
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Fecal immunochemical testing has become the most commonly used method for colorectal cancer screening worldwide

Interventions, such as patient navigators and provider reminders, may improve follow-up colonoscopy rates after a positive faecal blood test, according to the findings from a systematic evidence review published in Annals of Internal Medicine.

Faecal immunochemical testing has become the most commonly used method for colorectal cancer screening worldwide and is increasingly used in the United States to improve population-level screening rates. However, the proportion of test-positive patients having a timely colonoscopy after a positive test is generally low, suggesting a need to identify proven interventions that can be implemented in practice to improve follow-up colonoscopy rates.

In their study, ‘Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests: A Systematic Review’, the team of investigators led by Kaiser Permanente Division of Research, reviewed published studies to identify interventions that have been evaluated for improving rates of follow-up colonoscopy after positive faecal test results in asymptomatic adults.

The researchers identified 23 studies that met their inclusion criteria, including seven randomised and 16 nonrandomized studies.. While most of the research was low-quality, particularly with regard to system-level interventions, the team found moderate evidence to support the implementation of patient- and provider-level interventions.

The evidence suggests that the use of patient navigators, or individuals who work with patients to counsel and guide them through the barriers associated with cancer care, can increase rates of follow-up colonoscopy. Provider-level interventions that utilise electronic reminders to alert physicians of patients who have not taken adequate action after a positive test result were shown to improve colonoscopy completion from 9 to 25 percentage points.

The researchers note that these findings are important because until now, research on follow up of positive faecal blood tests in colorectal cancer screening has been hard to find. Since most of the research is low-quality, more research is needed to provide good, quality evidence for effective interventions.