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BACKGROUND: Delays in diagnostic colonoscopy after abnormal stool-based colorectal cancer screening are common in health-disparity populations and are associated with more advanced-stage disease at diagnosis. We evaluated the effectiveness of interventions designed to increase completion of diagnostic colonoscopy after abnormal fecal immunochemical test (FIT) or fecal occult blood test (FOBT) results in these populations.

METHODS: We searched six databases from inception through September 23, 2024 (updated June 4, 2025), for randomized trials, nonrandomized controlled studies, and controlled pre-post studies of interventions to improve colonoscopy completion after abnormal FIT or FOBT in health-disparity populations, as defined by the U.S. Department of Health and Human Services. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty with GRADE. Studies were pooled within intervention types (PROSPERO CRD42024591109).

RESULTS: Ten studies met inclusion criteria: patient navigation (8), a registry-based quality-improvement collaborative (1), and low-touch result notification (1). In the registered primary analysis-navigation, with completion over each study's own window-navigation increased completion versus usual care (risk ratio [RR], 1.27; 95% CI, 1.10-1.46; moderate certainty). The effect was stable when all interventions were pooled as registered (RR, 1.28; 95% CI, 1.12-1.46) and across analytic choices, and was consistent in post hoc analyses at 6 months (RR, 1.29; 95% CI, 0.97-1.71) and 12 months (RR, 1.34; 95% CI, 1.20-1.49; I2 = 0%). Pooled effects did not differ between randomized and nonrandomized studies. The other two strategies rested on single studies; detection data were sparse.

DISCUSSION: Patient navigation improves timely diagnostic colonoscopy completion after abnormal stool-based screening in health-disparity populations (moderate certainty); other strategies increased completion but rest on single studies. Limitations include intervention heterogeneity, varying follow-up intervals, and few studies per intervention type. Standardized time-based follow-up benchmarks and expanded navigation may advance equity. This study received no external funding.

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