Strategies to improve colorectal cancer screening rates
• Objective: To review the literature on interventions designed to increase rates of colorectal cancer screening in the United States. • Methods: The MEDLINE database and Cochrane Database of Systematic Reviews were searched for randomized and quasi-randomized controlled trials, systematic reviews, and observational studies of interventions to increase colorectal cancer screening. Additional studies were identified by reviewing the reference lists of reviewed articles. Intervention was broadly defined as a strategy beyond current care to increase colorectal cancer screening rates among eligible individuals. • Results: Interventions targeted at changing provider behavior, including automated reminders, were most successful when baseline screening rates were below the national average, approximately 55%. Similarly, interventions aimed at patient behaviors, including decision aid videos and written materials, were more likely to succeed if the preintervention screening rates were relatively low. • Conclusion: No intervention, either patient- or provider-based, appears to be successful at increasing screening rates in all study populations. With most interventions, the improvements seen in populations with low baseline screening rates were not seen in populations where baseline screening rates were at or above the national average. Future research is needed to test which approaches (eg, multifaceted interventions) are required to impact colorectal cancer screening in populations where baseline screening rates are greater than 55% but still below target.
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