Systematic review of interventions to promote colorectal cancer screening: Benchmarking effect sizes and screening rates.

Abstract

Objective: The effectiveness of behavioral interventions is typically evaluated relative to control conditions using null hypothesis significance testing (i.e., p < .05) or effect sizes. These criteria overlook comparisons with previous interventions and do little to promote a cumulative science of behavior change. We conducted a systematic review of the effectiveness of interventions to promote colorectal cancer screening (CCS) and generated benchmarks via the percentile distribution of ORs, screening rates for intervention and control arms, and differential screening rates (intervention minus control rate) in respective trials.

Method: Literature searches identified 187 eligible tests (N = 371,018).

Results: Random effects meta-analysis computed a sample-weighted OR = 1.69 (95% CI [1.55, 1.84]) and meta-regression showed that there was no improvement in the effectiveness of CCS interventions between 1996 and 2022. Benchmarking indicated that the median effect size was OR = 1.32, equivalent to a 35.7% screening rate in the intervention arm, and a 5.9% differential screening rate. Benchmarks were also generated for different types of screening (e.g., fecal immunochemical test, colonoscopy), sample characteristics (e.g., race, socioeconomic status), and methodological features (e.g., control conditions).

Conclusions: Interventions to promote CCS have a small effect and effectiveness has not increased over time. The percentile values for effect sizes and screening rates reported here can be used to benchmark the effectiveness of future trials. Benchmarking offers a way to evaluate interventions that are grounded in accumulated evidence and can inform judgments about tradeoffs among effectiveness, reach, and cost. (PsycInfo Database Record (c) 2024 APA, all rights reserved).