Navigation and Reminders Improve Colonoscopy Follow-Up After Abnormal Stool Screening Tests

A systematic review and meta-analysis in JAMA Internal Medicine evaluated interventions to improve follow-up colonoscopy after abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT) results. Researchers searched three databases through May 9, 2026, and included 21 randomized or nonrandomized interventional studies involving 19,613 patients aged 50–75 years. Outcomes were colonoscopy completion prevalence and relative risks, pooled using random-effects models.

Colonoscopy completion was higher with patient navigation (RR, 1.24; 95% CI, 1.15–1.33), patient reminders (RR, 1.32; 95% CI, 1.04–1.67), clinician reminders (RR, 1.36; 95% CI, 1.12–1.65), and automated referrals for gastrointestinal consultation (RR, 1.68; 95% CI, 1.09–2.60). Completion occurred in 4,755 of 10,263 control participants and 6,272 of 9,350 intervention participants. Pooled prevalence estimates were 47.8% and 69.1%, respectively.

These findings support patient- and system-level approaches to closing gaps in follow-up after abnormal stool screening results. However, heterogeneity was moderate to high across intervention categories, with I² values ranging from 57.1% to 94.4%. Excluding outliers reduced heterogeneity for several approaches, but moderate heterogeneity remained for automated referrals. The authors called for further evaluation of automated referrals and the incremental contributions of individual components in multicomponent interventions. The reported endpoint was colonoscopy completion, not colorectal cancer morbidity or mortality; full text was unavailable for this assessment.