Effect of Behavioral Interventions on the Uptake of Colonoscopy for Colorectal Cancer Screening: A Systematic Review and Meta-Analysis

Abstract

Background: Screening decreases colorectal cancer (CRC) incidence and mortality, but uptake in the United States remains suboptimal. Prior studies have investigated the effect of various interventions on overall CRC screening and stool-based testing, but the effect on colonoscopy—the predominant screening test in the US—has not been fully examined. We performed a systematic review and meta-analysis to assess the effect of behavioral interventions on screening colonoscopy uptake. Methods: We searched PubMed, EMBASE, and Cochrane databases through January 2022 for controlled trials that assessed the effect of behavioral interventions on screening colonoscopy uptake. All titles, abstracts, and articles were screened by at least two independent reviewers. Odds ratios were extracted from the original article or calculated from the raw data. The primary outcome was the relative increase in screening colonoscopy completion with any behavioral intervention. We performed random effects meta-analysis, with subgroup analysis by type of intervention. Results: A total of 25 studies with 30 behavioral interventions were analyzed. The most common interventions were patient navigation (n=11) and multi-component interventions (n=6). Overall, behavioral interventions increased colonoscopy completion by 54% compared to controls (OR 1.54, 95% CI 1.26-1.88). Patient navigation (OR 1.78, 95% CI 1.35-2.34) and multi-component interventions (OR 1.84, 95% CI 1.17-2.89) had the strongest effect on colonoscopy completion among interventions examined in multiple studies. Significant heterogeneity was observed both overall and by intervention type. There was no evidence of publication bias. Conclusions: 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.

Endoscopy: Scoping the Way Forward

“…There are numerous randomized controlled trials (3–8) in this special issue, ranging from submucosal injection for resection of small polyps (5) to comparisons of motorized spiral vs single-balloon enteroscopy (7). The issue includes diverse articles, including a systematic review of behavioral interventions to increase the uptake of colorectal cancer screening (9), to timely reviews on topics such as colonoscopy surveillance in inflammatory bowel disease (10) and performing high-quality, safe, cost-effective, and efficient basic colonoscopy in 2023 (11). In addition to exploring procedures such as endoscopic vacuum therapy (12) and endoscopic sleeve gastroplasty (13), we highlight a number of new procedural techniques, such as endoscopic approaches to cholecystitis (14,15), advances in bariatric endoscopy (16), and the novel field of endohepatology with liver biopsy and recurrent hepatic encephalopathy (4,17,18).…”

“…In addition to these important advances, this issue contains opinions and studies from key leaders in the field about taking ownership of complications (23), the art of maintaining communication (24), focusing on effective educational approaches (9), and appropriate postendoscopy care (25). These articles underline the importance of consolidating gains by improving education and communication as we move forward to newer avenues of endoscopy.…”