S631 Comparative Efficacy of Multilevel Interventions for Increasing Colorectal Cancer Screening Uptake: A Network Meta-Analysis

Introduction: Colorectal cancer (CRC) screening reduces CRC mortality, yet uptake remains suboptimal. Various interventions aim to improve screening rates, but their comparative effectiveness is unclear. We evaluated and compared the effectiveness of interventions aimed at increasing colorectal cancer screening uptake. Methods: We conducted a comprehensive search to identify randomized clinical trials (RCTs) evaluating strategies to improve CRC screening uptake, including patient navigation, mailed FIT outreach, educational multimedia, reminders, choice-based outreach, colonoscopy outreach, usual care, and others. A network meta-analysis compared interventions using risk ratios (RRs) with 95% confidence intervals (CIs). P-scores and rankograms assessed relative effectiveness. Results: Seventy-four RCTs involving 395,136 participants, with a mean age of 56.2 years (range: 45–75) was included for analysis. Patient navigation (RR 1.58, 95% CI 1.23-2.02; P-score 0.81) and mailed FIT outreach (RR 1.36, 95% CI 1.07-1.74; P-score 0.79) were the most effective, significantly outperforming usual care. Educational multimedia (RR 1.27, 95% CI 0.91-1.78; P-score 0.59) and reminder-only interventions (RR 1.24, 95% CI 0.98-1.57; P-score 0.48) showed modest effects. Choice-based outreach (RR 0.85, 95% CI 0.63-1.15) and colonoscopy outreach (RR 0.99, 95% CI 0.66-1.49) were not significantly better than usual care. Mailed FIT outreach outperformed colonoscopy outreach (RR 1.35, 95% CI 1.11-1.63), and patient navigation was superior to reminder-only interventions (RR 1.48, 95% CI 1.14-1.94). Sensitivity analyses showed mailed FIT outreach was most effective in low baseline uptake populations (<30%; RR 3.12, 95% CI 1.70-5.71), while educational multimedia led in high baseline uptake settings (≥30%; RR 1.22, 95% CI 1.04-1.44). Over time (2021-2024), educational multimedia ranked highest (RR 1.39, 95% CI 0.78-2.45; P-score 0.7290). Meta-regression showed no significant association between gender and race, while screening participation increased with age. Node splitting analysis indicated no significant inconsistence for all comparisons. Conclusion: Interventions aimed at increasing CRC screening varies by baseline uptake levels. Patient navigation and mailed FIT outreach are the most effective strategies for increasing colorectal cancer screening uptake, particularly in low baseline uptake populations. Educational multimedia shows promise in recent years and high baseline uptake settings, offering a scalable alternative.