Interventions Linked to Higher Colonoscopy Completion After Positive FIT/FOBT

Patient navigation, patient reminders, and clinician reminders were associated with increased completion of follow-up colonoscopy after an abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT) result, according to a systematic review and meta-analysis published in JAMA Internal Medicine.

Colorectal cancer is the second leading cause of cancer mortality worldwide. Although FIT and FOBT are established cost-effective screening modalities for colorectal cancer, follow-up colonoscopy rates remain suboptimal, the investigators noted. They searched MEDLINE, Embase, and Cochrane databases from inception to May 9, 2026, for randomized clinical trials and nonrandomized interventional studies comparing interventions to improve follow-up colonoscopy, and pooled results using a random-effects meta-analysis.

The analysis included 21 studies involving 19,613 patients aged 50 to 75 years, 58.7% of whom were male. Patient navigation (risk ratio [RR], 1.24; 95% CI, 1.15-1.33), patient reminders (RR, 1.32; 95% CI, 1.04-1.67), and clinician reminders (RR, 1.36; 95% CI, 1.12-1.65) were associated with greater colonoscopy completion. Automated referrals to gastrointestinal consult also showed a higher completion rate (RR, 1.68; 95% CI, 1.09-2.60). Pooled prevalence of follow-up colonoscopy was 47.8% in control groups and 69.1% after interventions.

The investigators detected moderate to high heterogeneity within and across intervention types. In sensitivity analyses excluding outliers, heterogeneity was low for patient navigation, patient reminders (messaging), and clinician reminders, whereas moderate heterogeneity remained for automated referrals.

The authors concluded that more studies are needed to evaluate the efficacy of automated referrals to gastrointestinal consult, given large heterogeneity between studies, and to assess the incremental effect of each intervention within multicomponent interventions.

Source: Chua WY, Chew LX, Chan CKM, et al. Evaluation of intervention strategies to improve follow-up colonoscopy after abnormal FIT/FOBT result: a systematic review and meta-analysis. JAMA Intern Med. Published online October 5, 2026. doi:10.1001/jamainternmed.2026.4827