Behavioral Interventions Foster Screening Colonoscopy Uptake
A large systematic review and meta-analysis found that behavioral interventions can significantly increase rates of colonoscopy screening.
Researchers analyzed 25 studies that assessed the effect of behavioral interventions on screening colonoscopy uptake in roughly 30,000 adults.
The 30 interventions in the analysis were categorized as letter, informational brochure, patient navigation, telephone consult, primary care provider (PCP) counseling, video, electronic health record alert, email, or financial incentive. Studies with two or more interventions were classified as multi-component.
The primary outcome was the relative increase in screening colonoscopy completion with any behavioral intervention. Random effects meta-analysis, with subgroup analysis by intervention type, was performed.
Overall, behavioral interventions increased colonoscopy screening completion by 54% compared with usual care (odds ratio [OR], 1.54).
The most common interventions were patient navigation (11 studies) and multi-component (six studies).
Patient navigation and multi-component interventions also were most consistently effective for improving uptake (OR, 1.78 and 1.84, respectively).
The single study evaluating PCP counseling found that it was highly effective, but the result requires confirmation.
“Behavioral interventions increase screening colonoscopy completion and should be adopted in clinical practice. In particular, patient navigation and multi-component interventions are the best-studied and most effective interventions,” the authors write.
The study, with first author Stephanie Yakoubovitch, MD, of Florida Atlantic University in Boca Raton, was published online August 22 in the American Journal of Gastroenterology. The study was funded by the National Cancer Institute.
Significant heterogeneity was observed both overall and by intervention type. It was unclear whether the intervention effect differed by age in the six trials that included adults younger than 50 years.
Corresponding author Peter Liang, MD, MPH, with NYU Langone Health, received research support from Epigenomics and Freenome and is on the advisory board for Guardant Health.
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