Evaluation of Letters Promoting Colorectal Cancer Testing

Not Applicable

Completed

• Conditions: Cancer Colorectal
• Interventions: Behavioral: Letter; Behavioral: Loss Frame and Fear Appeals; Behavioral: Transparency; Behavioral: Default Effect and Presentation of Alternatives; Behavioral: Enhanced Fear Appeals and Decoy Effect

• Registration Number: NCT04548765
• Lead Sponsor: Geisinger Clinic

Brief Summary

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).

Detailed 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.

Study Timeline

• Study Start: 2020-07-24
• Study First Submitted: 2020-09-04
• Study First Submitted QC: 2020-09-14
• Study First Posted: 2020-09-16
• Primary Completion: 2021-01-24
• Study Completion: 2021-07-23
• Status Verified: 2021-09
• Last Update Submitted: 2021-09-22
• Last Update Posted: 2021-09-24

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 14644

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

Study & Design

• Study Type: INTERVENTIONAL
• Study Design: FACTORIAL

Arm && Interventions

Group	Intervention	Description
Letter with Risks	Letter	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.
Letter with Risks and Options	Letter	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.
Letter with Risks	Transparency	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.
Standard Letter	Letter	The standard letter describes the importance of getting screened and instructs recipients how to use the FIT kit for screening at home.
Letter with Risks	Loss Frame and Fear Appeals	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.
Letter with Risks and Options	Default Effect and Presentation of Alternatives	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.
Letter with Risks and Options	Enhanced Fear Appeals and Decoy Effect	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.
Letter with Risks, Options, and Consequences for Inaction	Letter	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.
Letter with Risks and Options	Loss Frame and Fear Appeals	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.
Letter with Risks, Options, and Consequences for Inaction	Loss Frame and Fear Appeals	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.
Letter with Risks, Options, and Consequences for Inaction	Enhanced Fear Appeals and Decoy Effect	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.

Primary Outcome Measures

Name	Time	Method
FIT Kit Return at 6 months	6 months from intervention start date	Binary variable indicating whether a valid FIT kit was returned for testing
Colonoscopy Ordered at 6 months	6 months from intervention start date	Binary variable indicating whether a colonoscopy was ordered

Secondary Outcome Measures

Name	Time	Method
FIT Kit Return at 12 months	12 months from intervention start date	Binary variable indicating whether a valid FIT kit was returned for testing (a longer time frame allows for late responses)
FIT Kit Result	12 months from intervention start date	Binary variable indicating whether the test was positive or negative (if FIT kit was returned)
Colonoscopy Result	12 months from intervention start date	Binary variable indicating whether the test was positive or negative (if colonoscopy was completed)
Colonoscopy Completed	12 months from intervention start date	Binary variable indicating whether the colonoscopy was completed (if colonoscopy was ordered)
Colonoscopy Ordered at 12 months	12 months from intervention start date	Binary variable indicating whether a colonoscopy was ordered (a longer time frame allows for late responses)

Trial Locations

Locations (1)

Geisinger; 🇺🇸 Danville, Pennsylvania, United States