Positive stool test? Simple follow-up steps boost colonoscopy rates

Clinical takeaway: Do not assume a positive FIT or FOBT result will automatically lead to colonoscopy. Structured follow-up strategies, including patient navigation, reminder systems, and clinician prompts, substantially improve completion of the diagnostic colonoscopy needed to realize the benefits of stool-based colorectal cancer screening.

Stool-based colorectal cancer screening is convenient and widely used, but its effectiveness depends on timely colonoscopy after an abnormal result. Previous studies have found that only about one-third to one-half of patients complete follow-up colonoscopy, leaving many high-risk patients without definitive evaluation.

A systematic review and meta-analysis pooled 21 studies involving more than 19,600 adults with abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT) results. Across the studies, just 47.8% of patients in control groups completed follow-up colonoscopy. Interventions increased that figure to 69.1%, an absolute gain of more than 20 percentage points.

Several approaches performed similarly well. Patient navigation programs, which often included education, scheduling assistance, and barrier assessment, increased colonoscopy completion by about 24%. Patient reminders increased completion by about 32%, while clinician reminders improved rates by about 36%. Automated referrals to gastroenterology showed the largest estimated effect, increasing completion by roughly 68%, although results were more variable and based on fewer studies. Notably, text-message reminders appeared more effective than telephone reminders in the studies that directly examined reminder methods.

Even with intervention, follow-up rates remained below the 80% benchmark recommended by colorectal cancer screening experts. The authors concluded that both patient-level and system-level strategies can help close this persistent care gap, while future research should determine whether combining interventions can drive rates higher.

An accompanying editorial emphasized that clinicians need not wait for the perfect program. As the editorialists wrote, practices should choose "an approach that is sensible for their own clinical setting," recognizing that "it is important and effective to do something, rather than nothing."

Source: Chua WY, et al. (2026 Oct 5) JAMA Intern Med. Evaluation of Intervention Strategies to Improve Follow-Up Colonoscopy After Abnormal FIT/FOBT Result: A Systematic Review and Meta-Analysis