Design: Systematic review and meta-analysis of randomised and nonrandomised interventional studies
Population: 21 studies, 19,613 patients aged 50–75 with an abnormal faecal test
Primary outcome: Follow-up colonoscopy completion
Effect: Navigation RR 1.24 (1.15–1.33); clinician reminders RR 1.36 (1.12–1.65); completion 47.8% vs 69.1%

A systematic review and meta-analysis in JAMA Internal Medicine pooled 21 studies, including about 19,600 patients aged 50 to 75, of interventions to raise colonoscopy completion after an abnormal FIT or faecal occult blood test.

Patient navigation (RR 1.24), patient reminders (RR 1.32), clinician reminders (RR 1.36) and automated referral to gastroenterology (RR 1.68) all increased completion. Pooled completion rose from about 48% in control groups to 69% with an intervention. Heterogeneity was high, falling for most approaches once outliers were removed.

A positive faecal test that never reaches colonoscopy is a missed cancer waiting to happen, and in general medicine clinics the result often lands after the patient has left. Simple systems — a reminder, a named navigator, an automatic referral — make a large difference.

Track every abnormal FIT result until colonoscopy is done or declined.
Set up an automatic referral or clinician reminder when a positive result is filed.
Use a nurse or coordinator to contact patients who have not booked.
Record a patient's informed decision if they decline colonoscopy.

Why it matters

Half of positive screening tests went unfollowed in the control groups.

The statistics, in plain English

A risk ratio of 1.36 means completion was 36% higher with clinician reminders. High I² indicates the size of benefit varied considerably between settings, though all approaches pointed the same way.