CS.3.7 Cost-Effectiveness of Medical Counselling in Faecal Occult Blood-Positive Subjects. Experience of Trentino Screening Program

Fasoli, R.; Pace, Nicola; Pretis, G. De; Faitini, K.; Mastromauro, M.; Armelao, Franco; Nollo, Giandomenico

doi:10.1016/s1590-8658(10)60022-9

Cited by 1 publication

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“…The number of fecal test–positive patients ranged from 14 to 39 105; the number of patients included was not reported in 2 studies. Fourteen studies reported government funding, 2 corporate funding (38, 41), 1 funding from local volunteer organizations (42), and 9 did not specify any funding sources (7, 31, 32, 34, 43–46). Five studies investigated follow-up of fecal immunochemical tests (38, 43, 46–48) and 18 of guaiac-based FOBTs.…”

Section: Resultsmentioning

confidence: 99%

“…The 11 patient-level intervention studies used the following 3 general strategies: changes to the screening invitation strategy (38, 42), provision to patients of test results or follow-up appointments (33, 43, 45, 47), and patient navigator programs (31, 32, 39, 40, 48). …”

Section: Resultsmentioning

confidence: 99%

“…However, this study included some patients with CRC symptoms and counted several possibilities of test resolution other than colonoscopy, making the results less comparable to those of other studies. The other 3 studies used similar navigators, who provided personalized contact and problem solving to patients, but were observational studies with high or very high risk of bias (31, 32, 48). …”

Section: Resultsmentioning

confidence: 99%

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Interventions to Improve Follow-up of Positive Results on Fecal Blood Tests

et al. 2017

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Background: Fecal immunochemical testing is the most commonly used method for colorectal cancer screening worldwide. However, its effectiveness is frequently undermined by failure to obtain follow-up colonoscopy after positive test results. Purpose: To evaluate interventions to improve rates of follow-up colonoscopy for adults after a positive result on a fecal test (guaiac or immunochemical). Data Sources: English-language studies from the Cochrane Central Register of Controlled Trials, PubMed, and Embase from database inception through June 2017. Study Selection: Randomized and nonrandomized studies reporting an intervention for colonoscopy follow-up of asymptomatic adults with positive fecal test results. Data Extraction: Two reviewers independently extracted data and ranked study quality; 3 rated overall strength of evidence for each category of study type. Data Synthesis: Twenty-three studies were eligible for analysis, including 7 randomized and 16 nonrandomized studies. Three were at low risk of bias. Eleven studies described patient-level interventions (changes to invitation, provision of results or follow-up appointments, and patient navigators), 5 provider-level interventions (reminders or performance data), and 7 system-level interventions (automated referral, precolonoscopy telephone calls, patient registries, and quality improvement efforts). Moderate evidence supported patient navigators and provider reminders or performance data. Evidence for system-level interventions was low. Seventeen studies reported the proportion of test-positive patients who completed colonoscopy compared with a control population, with absolute differences of −7.4 percentage points (95% CI, −19 to 4.3 percentage points) to 25 percentage points (CI, 14 to 35 percentage points). Limitation: More than half of studies were at high or very high risk of bias; heterogeneous study designs and characteristics precluded meta-analysis. Conclusion: Patient navigators and the provision to providers of reminders or performance data may help improve colonoscopy rates of asymptomatic adults with positive fecal blood test results. Current evidence about useful system-level interventions is scant and insufficient.

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