Design: Systematic review and meta-analysis of randomised and non-randomised studies
Population: 21 studies, 19,613 adults aged 50 to 75 with an abnormal FIT or FOBT
Primary outcome: Completion of follow-up colonoscopy
Effect: Navigation RR 1.24 (1.15 to 1.33); automated referral RR 1.68 (1.09 to 2.60); pooled 47.8% to 69.1%

A meta-analysis pooled 21 randomised and non-randomised studies, 19,613 patients, testing ways to get people to colonoscopy after an abnormal faecal immunochemical or occult blood test.

Patient navigation (RR 1.24, 95% CI 1.15 to 1.33), patient reminders (RR 1.32), clinician reminders (RR 1.36) and automated referral to gastroenterology (RR 1.68) each increased completion. Overall, completion rose from about 48% in control groups to 69% with an intervention. Heterogeneity was high, especially for automated referral.

A positive faecal test with no colonoscopy wastes the screening and leaves a raised cancer risk unaddressed. Half of patients not completing it without help is a striking gap.

Treat a positive faecal blood test as a referral, not a result to file
Set up an automatic gastroenterology referral or flag when the test is positive
Follow up with the patient by phone or message if colonoscopy has not been booked
Check for a pending colonoscopy when you see a patient for anything else

Why it matters

Without help, about half of patients in control groups never had the colonoscopy their test called for.

The statistics, in plain English

Risk ratios of 1.24 to 1.68 mean completion rose by roughly a quarter to two-thirds. High I² values mean effects varied a lot between settings, so the exact gain in any one clinic is uncertain.