Incomplete diagnostic follow-up after a positive colorectal cancer screening test: a systematic review.

Background: Colorectal cancer (CRC) screening using faecal occult blood or faecal immunological testing (FOBT/FIT) involves completion of a screening test-then if required a follow-up diagnostic test.

Methods: A systematic review, of EMBASE, MEDLINE, the Cochrane Library and Google Scholar, of studies up to 2016. Studies explored characteristics behind, reasons for and interventions to reduce incomplete diagnostic testing after a positive FOBT/FIT in CRC screening.

Results: A total of 68 articles were included (63 studies). There is evidence of disparities in uptake by socioeconomic position and ethnicity, as well as geographic remoteness. Positive health beliefs, health knowledge and CRC screening attendance history are associated with increased diagnostic testing. Facets of organised screening, including performance feedback and funding improve follow-up-whilst guidelines increase diagnostic testing and reduce inappropriate exclusions. Between 2 and 11% of participants refuse follow-up, with perception of pain critical. Interventions, notably a screening specialist to aid the patient journey, as well as tracking and reminder systems, can increase diagnostic testing.

Conclusions: Although rates of non-attendance in those eligible are low, this represents a group with health care need. Disparities must be eliminated to alleviate wider health inequity. Organised, screening can reduce incomplete diagnostic testing, as can accessible health information.