Financial Incentives to Increase Colorectal Cancer Screening in Priority Populations

Not Applicable

Completed

• Conditions: Colorectal Cancer
• Interventions: Behavioral: Auto Mailing Plus Money; Behavioral: Auto Mailing Plus Lottery

• Registration Number: NCT03080701
• Lead Sponsor: Kaiser Permanente

Brief Summary

The investigators propose to build on the success of the Systems of Support to Increase Colorectal Cancer trial (SOS, R01CA121125, Green) and focus on disparity groups who are less likely to be current for colorectal cancer (CRC) screening. We will test whether financial incentives increases screening uptake and decreases screening disparities. The investigators hypothesize that CRC screening rates will be higher in patients offered mailed fecal kits and financial incentives than those offered mailed fecal kits alone.

Detailed Description

Study staff will send invitation letters and a questionnaire to 5,000 patients aged 50-75 not current for CRC screening, two-thirds who are identified in the electronic data as being from a non-White race, ethnicity, or who have Medicaid coverage. Those returning the survey and remaining eligible (estimated N = 1150) will be randomized to either (1) Mailed fecal kit only, or mailed fecal kit plus one of 2 types of financial incentives for completing testing: (2) a guaranteed Monetary incentive or (3) a probabilistic Lottery incentive.

Study Timeline

• Study First Submitted: 2017-01-31
• Study First Submitted QC: 2017-03-09
• Study First Posted: 2017-03-15
• Study Start: 2017-03-23
• Primary Completion: 2018-11-02
• Study Completion: 2018-11-02
• Status Verified: 2019-11
• Last Update Submitted: 2019-11-04
• Last Update Posted: 2019-11-05

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 898

Inclusion Criteria

• No evidence in electronic data of FIT screening in past year or a colonoscopy in the prior 9 years.
• Continuously enrolled in Group Health Cooperative (GHC) for at least one year.
• Patients who have Medicaid coverage or are non-white race or Hispanic any race.

Exclusion Criteria

• Known high risk for CRC
• History of CRC
• History of inflammatory bowel disease
• Current anticoagulation therapy
• Organ failure
• Serious illness
• Debilitating disease
• Dementia
• Nursing home resident

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: PARALLEL

Arm && Interventions

Group	Intervention	Description
Group 2 - Auto Mailing Plus Money	Auto Mailing Plus Money	Receives the same number of mailings and materials as group 1 with the following modifications. In Mailing 1 the letter will include the intervention notification that they will receive a monetary thank you gift for completing testing (FIT colonoscopy or flex sig within 6 months). Mailing 2 and mailing 3 (reminder letters for those still not returning kits) will include the same information about the monetary thank you gift for CRC screening completion. Mailing 4 will include the money with a thank you letter for those who complete the screening
Group 3 - Auto Mailing Plus Lottery	Auto Mailing Plus Lottery	Receives the same number of mailings and materials as group 1 with the following modifications. In Mailing 1 the letter will include the intervention notification that they will have a 1 in 10 chance of winning money (FIT, colonoscopy or flex sig within 6 months). Mailing 2 and mailing 3 (reminder letters for those still not returning kits) will include the same information about the 1 in 10 chance of winning the lottery for CRC screening completion. Mailing 4 will include a thank you letter with money for those who complete their screening and win the lottery. Participants who do not win the lottery will receive a thank you letter.

Primary Outcome Measures

Name	Time	Method
CRC Screening Within 6 Months Following Randomization	6 months	We will compare among the 3 arms (1) automated mailing; (2) Auto mailing plus $10; (3) Auto mailing plus $50 lottery for completion and the effect of each on CRC screening completion at 6 months (yes/no) within the following subgroups of each arm: 1. White and not Hispanic versus non-White or Hispanic. 2. Medicaid versus non-Medicaid (Medicare, employer-based, private) insurance. 3. History of prior versus no prior completion of CRC screening tests. 4. High school or less versus college or more education level.

Trial Locations

Locations (1)

Group Health Research Institute; 🇺🇸 Seattle, Washington, United States