Evaluation of Letters Promoting Colorectal Cancer Testing

Geisinger Health

Status: Completed

Conditions: Cancer Colorectal

Treatments: Behavioral: Loss Frame and Fear Appeals; Behavioral: Transparency; Behavioral: Default Effect and Presentation of Alternatives; Behavioral: Letter; Behavioral: Enhanced Fear Appeals and Decoy Effect

Study type: Interventional

Funder types: Other

Identifiers

NCT04548765

2020-0510

Details and patient eligibility

About

In this evaluation, 4 different versions of letters are being sent with mailers promoting colorectal cancer screening with an at-home test. The researchers hypothesize that the use of behavioral nudges in the message should lead to increased colorectal cancer screening (either with the at-home test or a colonoscopy).

Full description

Colorectal cancer (CRC) is the third most common cancer diagnosed in the US. Mailing fecal immunochemical (FIT) kits to at-risk patients is an effective way of increasing CRC testing uptake, as this test can be done at home and is less intrusive compared to colonoscopies. As part of an existing program, the health system mails FIT kits to eligible patients each year. Although this test needs to be conducted annually, not everyone who receives the test kit returns the kits for processing. In this study, the researchers aim to test different letters with the goal of encouraging the use of FIT kits or scheduling a colonoscopy.

As part of this study, the kits are mailed with everything the patient will need to conduct the test at home and mail a sample back to the hospital. It also includes an introductory letter informing the patient about the program and inviting them to use the kit. The researchers are comparing a standard version of the introductory letter against 3 versions that include different combinations of behavioral nudges, specifically framing effects (loss, default, decoy) and fear appeals.

Enrollment: 14,644 patients

Sex: All

Ages: 18+ years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• Enrollment in Medicare Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO; age 65 and older) or Commercial HMO in one large employer's group
• Has a flag indicating that the person is due for a colon cancer screening

Exclusion criteria

• Members who are on the do not contact list at Geisinger Health Plan

Trial design

Primary purpose: Screening

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Double Blind

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14,644 participants in 4 patient groups

Standard Letter

Active Comparator group

Description:

The standard letter describes the importance of getting screened and instructs recipients how to use the FIT kit for screening at home.

Treatment:

Behavioral: Letter

Letter with Risks

Experimental group

Description:

The standard letter is enhanced with language that further emphasizes the risks but also clearly describes how early detection with a test can reduce those risks; it also explains why test kits are being sent to disarm skepticism about the program.

Treatment:

Behavioral: Loss Frame and Fear Appeals

Behavioral: Transparency

Behavioral: Letter

Letter with Risks and Options

Experimental group

Description:

In addition to the enhancements added by the letter with risks, the letter also includes a table comparing FIT kit and colonoscopy. Presenting different screening options allows recipients to make the choice that best suits them. In addition, presenting multiple options increases the chance that recipients get screened in one way or another.

Treatment:

Behavioral: Loss Frame and Fear Appeals

Behavioral: Default Effect and Presentation of Alternatives

Behavioral: Letter

Behavioral: Enhanced Fear Appeals and Decoy Effect

Letter with Risks, Options, and Consequences for Inaction

Experimental group

Description:

In addition to the enhancements added by the letter with risk, the comparison table includes comparisons of the consequences of getting screened vs. waiting for symptoms to appear.

Treatment:

Behavioral: Loss Frame and Fear Appeals

Behavioral: Letter

Behavioral: Enhanced Fear Appeals and Decoy Effect