Reminders and navigation increase colonoscopy completion Patient navigation, patient reminders, clinician reminders, and automated referral improved colonoscopy completion after abnormal stool blood tests.
*Systematic review and meta-analysis of mixed studies; Level 2.

Citation

Chua WY, Chew LX, Chan CKM, et al. Evaluation of Intervention Strategies to Improve Follow-Up Colonoscopy After Abnormal FIT/FOBT Result. JAMA Internal Medicine. Published online October 5, 2026. doi:10.1001/jamainternmed.2026.4827

Background

Stool blood tests reduce colorectal cancer deaths only if abnormal results are followed by colonoscopy. Follow-up rates are often far below recommended targets.

Patients

19,613 adults, mostly ages 50 to 75, with abnormal fecal immunochemical or occult blood tests. Studies without controls, non-English reports, abstracts, and nonintervention designs were excluded.

Intervention

Patient navigation, patient reminders, clinician reminders, automated referral, or multicomponent programs.

Control

Usual care or less intensive follow-up.

Outcome

Completion of follow-up colonoscopy after an abnormal stool blood test.

Follow-up Period

1 month to 1 year; 2 studies did not specify.

Results

Intervention Effect on colonoscopy completion Approximate absolute impact
Patient navigation RR 1.24 (95% CI 1.15 to 1.33) NNT about 10
Patient reminders RR 1.32 (95% CI 1.04 to 1.67) NNT about 5
Clinician reminders RR 1.36 (95% CI 1.12 to 1.65) NNT about 4
Automated referral RR 1.68 (95% CI 1.09 to 2.60) NNT about 5

RR: risk ratio. CI: confidence interval. NNT: number needed to treat.

Overall, completion increased from 47.8% with control care to 69.1% after interventions, giving an approximate NNT of 5. Randomized trials used intention-to-treat analyses. Usual care was the current available approach.

Limitations

Interventions and follow-up timing varied widely, causing substantial heterogeneity. Nearly half the studies were nonrandomized. English-only inclusion, possible publication bias for navigation studies, and limited evidence on combined programs reduce certainty.

Funding

Singapore public research grants; funders had no role.

Clinical Application

After abnormal stool blood tests, use tracking, navigation, text reminders, and clinician alerts; evidence supports implementation but not one best strategy.