Informing Measurement of Timely Follow-up Colonoscopies After Positive Stool Tests for Two-Step Colorectal Cancer Screening: An Environmental Scan.

Abstract

Delays in the completion of two-step colorectal cancer (CRC) screening, consisting of follow-up colonoscopy after positive non-invasive testing, increase the risk of advanced-stage CRC diagnoses and poor health outcomes. This environmental scan aimed to inform the measurement of timely follow-up colonoscopy after positive stool tests. Two main data sources, UpToDate and PubMed, were used to identify society screening guidelines and peer-reviewed literature, respectively. Four websites and two databases were searched for related clinical quality measures. Additional society guidelines and literature were identified by handsearching. All data sources were used to find information on the types of stool tests and follow-up procedures used in two-step CRC screening, target populations for stool tests, follow-up rate benchmarks, and definitions of timely follow-up. Data were extracted and narratively synthesized. Eighteen guidelines, 32 peer-reviewed articles, and eight related clinical quality measures were included. Recent guidelines recommended asymptomatic, average-risk individuals aged 45-75 years undergo routine CRC screening. Modalities for stool tests were the fecal immunochemical test, high-sensitivity guaiac-based fecal occult blood test, and the multi-target stool DNA panel. Colonoscopy was the gold standard follow-up procedure for positive stool tests. Two guidelines proposed benchmarks of ≥ 80% within an unspecified time period and ≥ 95% within 180 days for follow-up colonoscopy completion rates. Only three guidelines defined timely follow-up, ranging from 56 to 180 days after a positive stool test. A meta-analysis comprising five studies included in this scan and a systematic review both reported significant increases in the risk of detecting CRC 180 days after positive stool tests. Sixteen studies reported follow-up colonoscopy rates among different health systems, with rates ranging from 42% to 81% within 180 days. This environmental scan highlighted a lack of consistent recommendations regarding definitions for timely follow-up colonoscopy after positive CRC screening stool tests and benchmarks for follow-up colonoscopy rates. Standardized measurement coupled with quality improvement interventions could serve to increase timely follow-up colonoscopy rates and improve CRC-related health outcomes.