Effect of Sequential or Active Choice for Colorectal Cancer Screening Outreach

Autor: David A. Asch, Catherine Reitz, David Santos, Chyke A. Doubeni, Timothy McAuliffe, Kevin G. Volpp, Vikranth R. Induru, Shivan J. Mehta, Charles Orellana
Rok vydání: 2019
Předmět:
Zdroj: JAMA Network Open
ISSN: 2574-3805
DOI: 10.1001/jamanetworkopen.2019.10305
Popis: Key Points Question Does the offering of choice between colonoscopy and fecal immunochemical testing (FIT) change participation in screening outreach? Findings In this 3-arm pragmatic randomized clinical trial of 438 patients, there was no statistically significant increase in screening when offering the choice of FIT compared with colonoscopy only, but fewer patients selected colonoscopy in the choice arms. Meaning Offering the choice of FIT in a colonoscopy outreach program did not substantially increase screening participation, but the framing of choice altered patient decision making.
This 3-arm pragmatic randomized clinical trial investigates response rates for offering colonoscopy only compared with sequential choice (colonoscopy and then fecal immunochemical testing) or active choice (colonoscopy or fecal immunochemical testing) through mailed outreach.
Importance Colonoscopy and fecal immunochemical testing (FIT) are considered top-tier tests for colorectal cancer (CRC) screening. Behavioral economic insights about “choice architecture” suggest that participation could be influenced by how people are presented test options. Objective To investigate response rates for offering colonoscopy only compared with sequential choice (colonoscopy and then FIT) or active choice (colonoscopy or FIT) through mailed outreach. Design, Setting, and Participants Three-arm pragmatic randomized clinical trial conducted between November 14, 2017, and May 14, 2018. The setting was primary care practices at an academic health system. Patients aged 50 to 74 years with at least 2 primary care visits in the 2-year preenrollment period were included if they were eligible but not up to date on CRC screening. Interventions Eligible patients received mailed outreach about CRC screening. Equal numbers of eligible patients were randomly assigned to 3 outreach groups to receive mailings about CRC screening with the following options: (1) direct phone number to call for scheduling colonoscopy (colonoscopy only), (2) direct phone number to call for colonoscopy and a mailed FIT kit if no response within 4 weeks (sequential choice), or (3) direct phone number to call for colonoscopy and a mailed FIT kit offered at the same time (active choice). Main Outcomes and Measures The primary outcome was CRC screening completion (FIT or colonoscopy) within 4 months of initial outreach. The secondary outcomes were CRC screening completion within 6 months of outreach and the choice of colonoscopy as a screening test. Results In total, 438 patients were included in the intent-to-treat analysis, with a median age of 56 years (interquartile range, 52-63 years); 55.0% were women. At 4 months, the CRC screening completion rates were 14.4% (95% CI, 8.7%-20.1%) in the colonoscopy-only arm, 17.1% (95% CI, 11.0%-23.2%) in the sequential choice arm, and 19.9% (95% CI, 13.4%-26.4%) in the active choice arm. Neither choice arm achieved a screening rate statistically greater than that in the colonoscopy-alone arm. Among those who completed CRC screening at 4 months, 90.5% (95% CI, 78.0%-103.0%) chose colonoscopy in the colonoscopy-only arm, which was significantly higher than the 52.0% (95% CI, 32.4%-71.6%; P = .005) and 37.9% (95% CI, 20.2%-55.6%; P
Databáze: OpenAIRE
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