Adherence to multi-target stool DNA screening and timeliness of follow-up colonoscopy: a real-world study from Tufts...

This study evaluated adherence to multitarget stool DNA (mt-sDNA) testing, positivity rate, and timeliness of follow-up colonoscopy (FU-CY) after a positive result in a large academic hospital, while examining patient- and provider-level predictors of adherence.

We conducted a retrospective cohort analysis of 14,256 patients aged 45-75 years who received an mt-sDNA order at Tufts Medical Center between 2016 and 2023. Adherence was defined as returning a completed kit within 1 year. Time to FU-CY was measured within 365 days of a positive mt-sDNA result. Logistic regression identified factors associated with adherence, adjusting for demographics, socioeconomic variables, insurance type, provider specialty, and patient return history.

Adherence was 71.7%, with a positivity rate of 13.3%; FU-CY completion after a positive test was 75.8% within 12 months. Younger patients (45-49 years) demonstrated the highest adherence to mt-sDNA (75.5%). Adherence to mt-sDNA was significantly higher among Asian or Pacific Islander patients compared with other racial/ethnic groups, and among Medicare/Medicare Advantage patients compared with commercial insurance. Lower adherence was observed in patients with household incomes of $25K-$50K and in patients new to mt-sDNA testing compared with those with prior test experience.

High mt-sDNA adherence and timely FU-CY completion suggest mt-sDNA is an effective, patient-acceptable option for colorectal cancer screening. However, disparities by age, race/ethnicity, income, and patient return history highlight the need for targeted outreach strategies to improve screening equity and follow-up completion.