Behavioral interventions can increase uptake of colorectal cancer screening colonoscopy by 54%, according to a new meta-analysis of 25 controlled studies with more than 30,000 participants.
Patient navigation was the single most effective intervention, and it is an approach that can be tailored to many demographics, including people with traditionally low levels of literacy and education, the researchers wrote.
“Studies such as ours will hopefully increase awareness among policymakers and health system leaders that investment in behavioral interventions will pay dividends for both patients and institutions,” the investigators stated, noting that while strategies like patient navigation may be resource-intensive, they yield a “net financial benefit to healthcare institutions by increasing colonoscopy volume.”
Other meta-analyses have examined the effects of behavioral interventions for CRC screening broadly, but “the lack of a systematic review summarizing the evidence for behavioral interventions for screening colonoscopy uptake is a major gap in the literature,” wrote the researchers, led by Stephanie Yakoubovitch, MD, a general surgery resident at the Schmidt College of Medicine at Florida Atlantic University, in Boca Raton.
To fill this gap, Dr. Yakoubovitch and her team systematically reviewed 25 controlled trials published before January 2022, including 21 randomized controlled trials and six population-based controlled trials. The studies included 30,064 participants and examined the effectiveness of 30 behavioral interventions for the uptake of screening colonoscopy (Am J Gastroenterol 2023;118[10]:1829-1840). The median follow-up was six months after intervention. Some of the studies focused on specific populations, such as low-income or from racial minority groups, or individuals younger than 50 years of age. Most of the studies (n=11) examined patient navigation alone, or other single interventions, such as mailed letters (3), informational brochures (3) and video calls (2). Six studies used a combination of two or more interventions.
According to Dr. Yakoubovitch and her co-investigators, people who received a behavioral intervention had a 54% higher rate of screening colonoscopy completion compared with those who did not receive this intervention (odds ratio [OR], 1.54; 95% CI, 1.26-1.88). The only interventions that had a statistically significant effect were patient navigators (OR, 1.78; 95% CI, 1.35-2.34) and multicomponent approaches (OR, 1.84; 95% CI, 1.17-2.89), many of which included patient navigation as a component.
When the researchers conducted sensitivity analyses excluding publications that focused specifically on low-income or racial minority groups in the United States—populations that historically have had low levels of education—they found the overall effect of behavioral interventions increased (OR, 1.71; 95% CI, 1.35-2.18), as well as a larger impact of patient navigation specifically (OR, 2.38; 95% CI, 1.90-2.98).
Additionally, both informational brochures (OR, 1.68; 95% CI, 1.25-2.26) and videos (OR, 5.28; 95% CI, 1.20-23.32) became significant interventions in their ability to increase screening colonoscopy completion.
The researchers said their findings strongly support the implementation of patient navigation services, even though they noted there was heterogeneity in how patient navigation was performed and organized across the studies in their analysis. In terms of the backgrounds of patient navigators, they ranged from laypersons to nurses and other healthcare professionals; and even the format of patient navigation was varied, ranging from scripted telephone calls to in-person meetings.
“Despite the heterogeneity in navigation programs, our findings suggest that if the principle of patient-centered care is observed,” the team wrote, “there can be many effective ways to perform patient navigation, and the approach can be both flexible and tailored to a specific population.”
—David Wild