Choice Architecture and Mailed Colorectal Cancer Screening Outreach in a Community Health Setting

Abramson Cancer Center at Penn Medicine

Status: Completed

Conditions: Colorectal Cancer

Treatments: Behavioral: FIT Only; Behavioral: Colonoscopy Only; Behavioral: Choice

Study type: Interventional

Funder types: Other; NETWORK

Identifiers

NCT04711473

UPCC 13220

843772

Details and patient eligibility

About

This is a 3-arm randomized trial aimed at increasing rates of participation in colorectal cancer (CRC) screening by outreach to patients' homes using choice architecture informed by behavioral science principles.

Full description

The investigators will evaluate the effectiveness of mailed outreach with choice between colonoscopy and FIT, and FIT alone, as compared to colonoscopy alone in increasing CRC screening rates.

Enrollment: 800 patients

Sex: All

Ages: 50 to 74 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

1. At least 1 visit with CHDC in the past 2 years
2. Not up to date on CRC screening (no evidence of colonoscopy in the last 10 years, sigmoidoscopy in the last 5 years, or stool testing in the past 12 months)

Exclusion criteria

1. History of CRC or polyps
2. Significant family history of CRC
3. History of Inflammatory Bowel Disease or Ulcerative Colitis
4. History of colectomy
5. History of metastatic cancer
6. Current use of Medication Assisted Therapy (MAT)

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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800 participants in 3 patient groups

Colonoscopy Only

Active Comparator group

Description:

Participants in this arm will receive a letter from their provider informing them they are overdue for colon cancer screening and requesting their participation in colonoscopy, and including a referral for the procedure at a local endoscopy center. Participants will be provided a phone number if interested in navigated colonoscopy scheduling.

Treatment:

Behavioral: Colonoscopy Only

Choice

Experimental group

Description:

Participants in this arm will receive a letter from their provider informing them they are overdue for colon cancer screening and requesting their participation in their choice of either colonoscopy or mailed fecal immunochemical testing (FIT). The letter will include both a referral for the colonoscopy at a local endoscopy enter and a FIT kit with a lab requisition and instructions for completion.

Treatment:

Behavioral: Choice

FIT Only

Experimental group

Description:

Participants in this arm will receive a letter from their provider informing them they are overdue for colon cancer screening and requesting their participation in FIT testing. The letter will include a FIT kit with lab requisition and instructions for completion.

Treatment:

Behavioral: FIT Only