P2655 - Comparative Efficacy of Multilevel Interventions for Increasing Colorectal Cancer Screening Uptake: A Network Meta-Analysis

Daryl Ramai, MD, MPH, MSc¹, Chun-Wei Pan, MD², Bjorn Rodriguez, MD³, Gedion Yilma Amdetsion, MD⁴, Azizullah Beran, MD⁵, Yichen Wang, MD⁶, Aasma Shaukat, MD, MPH, FACG⁷, Amy S.. Oxentenko, MD⁸, John Fang, MD⁹, Douglas Rex, MD⁵, John Inadomi, MD⁹
1Brigham and Women’s Hospital, Harvard Medical School, Salt Lake City, UT; 2Cook County Health and Hospital Systems, Chicago, IL; 3University of Missouri, Salt Lake City, UT; 4Cook County Health, Chicago, IL; 5Indiana University School of Medicine, Indianapolis, IN; 6Hospital of the University of Pennsylvania, Philadelphia, PA; 7NYU Grossman School of Medicine, Division of Gastroenterology and Hepatology, New York, NY; 8Mayo Clinic, Rochester, MN; 9University of Utah, Salt Lake City, UT

Introduction: Colorectal cancer (CRC) screening reduces CRC mortality, yet uptake remains suboptimal. Various interventions aim to improve screening rates, but their comparative effectiveness is unclear. We evaluated and compared the effectiveness of interventions aimed at increasing colorectal cancer screening uptake.

Methods: We conducted a comprehensive search to identify randomized clinical trials (RCTs) evaluating strategies to improve CRC screening uptake, including patient navigation, mailed FIT outreach, educational multimedia, reminders, choice-based outreach, colonoscopy outreach, usual care, and others. A network meta-analysis compared interventions using risk ratios (RRs) with 95% confidence intervals (CIs). P-scores and rankograms assessed relative effectiveness.

Results: Seventy-four RCTs involving 395,136 participants, with a mean age of 56.2 years (range: 45–75) was included for analysis. Patient navigation (RR 1.58, 95% CI 1.23-2.02; P-score 0.81) and mailed FIT outreach (RR 1.36, 95% CI 1.07-1.74; P-score 0.79) were the most effective, significantly outperforming usual care. Educational multimedia (RR 1.27, 95% CI 0.91-1.78; P-score 0.59) and reminder-only interventions (RR 1.24, 95% CI 0.98-1.57; P-score 0.48) showed modest effects. Choice-based outreach (RR 0.85, 95% CI 0.63-1.15) and colonoscopy outreach (RR 0.99, 95% CI 0.66-1.49) were not significantly better than usual care. Mailed FIT outreach outperformed colonoscopy outreach (RR 1.35, 95% CI 1.11-1.63), and patient navigation was superior to reminder-only interventions (RR 1.48, 95% CI 1.14-1.94). Sensitivity analyses showed mailed FIT outreach was most effective in low baseline uptake populations (< 30%; RR 3.12, 95% CI 1.70-5.71), while educational multimedia led in high baseline uptake settings (≥30%; RR 1.22, 95% CI 1.04-1.44). Over time (2021-2024), educational multimedia ranked highest (RR 1.39, 95% CI 0.78-2.45; P-score 0.7290). Meta-regression showed no significant association between gender and race, while screening participation increased with age. Node splitting analysis indicated no significant inconsistence for all comparisons.

Discussion: Interventions aimed at increasing CRC screening varies by baseline uptake levels. Patient navigation and mailed FIT outreach are the most effective strategies for increasing colorectal cancer screening uptake, particularly in low baseline uptake populations. Educational multimedia shows promise in recent years and high baseline uptake settings, offering a scalable alternative.


Figure: Figure 1: Network plot showing the relationship of intervention strategies


Figure: Table 1: Split‐evidence Forest plot comparing each intervention to usual-care control


Disclosures:
Daryl Ramai indicated no relevant financial relationships.
Chun-Wei Pan indicated no relevant financial relationships.
Bjorn Rodriguez indicated no relevant financial relationships.
Gedion Yilma Amdetsion indicated no relevant financial relationships.
Azizullah Beran indicated no relevant financial relationships.
Yichen Wang indicated no relevant financial relationships.
Aasma Shaukat: Freenome inc – Consultant.
Amy Oxentenko indicated no relevant financial relationships.
John Fang: Aspero Medical – Consultant. Circa Scientific – Consultant. Merit – Consultant.
Douglas Rex indicated no relevant financial relationships.
John Inadomi indicated no relevant financial relationships.

Daryl Ramai, MD, MPH, MSc¹, Chun-Wei Pan, MD², Bjorn Rodriguez, MD³, Gedion Yilma Amdetsion, MD⁴, Azizullah Beran, MD⁵, Yichen Wang, MD⁶, Aasma Shaukat, MD, MPH, FACG⁷, Amy S.. Oxentenko, MD⁸, John Fang, MD⁹, Douglas Rex, MD⁵, John Inadomi, MD⁹. P2655 - Comparative Efficacy of Multilevel Interventions for Increasing Colorectal Cancer Screening Uptake: A Network Meta-Analysis, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.