S713 FIT-Based Colorectal Cancer Screening Completion Rates (Initial Test and Follow-Up Colonoscopy) by Health Facility Type: A Systematic Review and Meta-Analysis

Introduction: Stool-based strategies for colorectal cancer (CRC) screening require completion of the initial test and follow-up colonoscopy (FU-COL) when positive. Health facilities that employ the fecal immunochemical test (FIT) for CRC screening may leverage patient navigation and/or other support interventions to increase FIT and FU-COL adherence. The objective of this study was to assess the effect of these interventions on both FIT adherence and FU-COL adherence within a year at Federally Qualified Health Centers (FQHCs), Safety-Net Facilities (SNFs), Rural Health Clinics (RHCs), and Indian Health Service (IHS) facilities. Methods: We searched only PubMed, EMBASE, and reference lists related to those articles to identify studies describing CRC screening test adherence. We included US-based, English-language manuscripts published from 1/1/2013 to 11/10/2023 and abstracts from 1/1/2020 to 11/10/2023. We excluded high-risk populations and studies describing population-based adherence. A random effects model was used to calculate the adherence rates for FIT and FU-COL after a positive FIT. Results: From review of 5,761 unique titles/abstracts, we included 38 FIT and 9 FU-COL adherence studies. We identified 16 and 12 individual interventions for FIT and FU-COL, respectively, which were implemented in 405 and 40 combinations, respectively. The most common interventions for FIT were postal communication recommending screening (13.8%), provision of test instructions (13.6%), CRC education (12.6%), and mailed FIT (11.9%). The most common intervention for FU-COL was scheduling support (20%). Overall, FIT adherence was 35.7% (95% CI: 30.1-41.4) and was higher among those receiving any intervention compared to the usual care (39.4% vs 26.1%, P = 0.033). Overall FU-COL adherence after a positive FIT was 46.6% (95% CI: 41.1-52.1) and was numerically higher with intervention compared to usual care (52.0% vs 45.3%, P = 0.39). Table 1 shows adherence by facility type. Conclusion: Even with navigation and/or other support interventions, FIT adherence and FU-COL after a positive FIT are suboptimal. Unequal access to FU-COL may contribute to disparities across health system types, with low adherence in resource-limited settings. These findings should be informative to CRC screening program decision-makers when considering the balance of resource investment vs achievable benefits from FIT-based strategies.