Improving the Message of Mailed Outreach Improves CRC Screening Adherence

Improving the Message of Mailed Outreach Improves CRC Screening Adherence

Douglas K. Rex, MD, FASGE, reviewing Bakr O, et al. Clin Transl Gastroenterol 2020 Jan.

Mailed outreach, in which a fecal immunochemical test (FIT) kit is sent directly to eligible patients, is increasingly recognized as a measure that improves colorectal cancer (CRC) screening adherence. This study was a randomized trial that incorporated principles of behavioral economics and social psychology to make a more persuasive message in the mailed outreach. 

In a randomized design, the usual care group got the mailed FIT kit and a letter describing features such as “colon cancer is the second most common cancer in the U.S.,” “screening is recommended every 1 to 10 years beginning at age 50,” “we have enclosed the FIT kit,” and “there are several options for screening.”

The intervention group also received a FIT kit and letter, but text was minimized, images offering colonoscopy and FIT were included, and messaging was revised to leverage behavioral economics and social psychology principles as follows: 

  • Choice overload (reduced the number of available tests to 2 to avoid choice overload): “You have options. You can be screened at the office with a colonoscopy or at home with your FIT kit.”
  • Salient costs and benefits (identified specific patient benefits of choosing an option): “Screening takes minutes at home” and “Screening that could save your life.”
  • Implied scarcity (inferred higher value): “You have been selected to complete a colon cancer screening that could save your life.”
  • Psychological ownership (fostered responsibility): “Your kit can detect signs of colon cancer.”
  • Defaults (provided an option if an active choice was not made): “Please return the included kit in the next 2 weeks.”

At 6 months, uptake was 19.5% in the usual care arm and 24.1% in the intervention arm (P=.02), or nearly a 25% increase in uptake. All the increase occurred in FIT uptake.

COMMENT
These data indicate that using principles of behavioral economics and social psychology improves uptake in a mailed outreach FIT program. Gastroenterologists developing organized screening programs should incorporate these messaging concepts.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Douglas K. Rex, MD, FASGE

CITATION(S)

Bakr O, Afsar-Manesh N, Raja N, et al. Application of behavioral economics principles improves participation in mailed outreach for colorectal cancer screening. Clin Transl Gastroenterol 2020;11:e00115. (https://doi.org/10.14309/ctg.0000000000000115)

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