Behavioral Economic Approaches for Population-based Colorectal Cancer Screening

PROJECT SUMMARY/ ABSTRACT This goal of this proposal is to develop and evaluate a multi-level intervention focused on the health system, clinicians, and patients that could increase colorectal cancer (CRC) screening rates by incorporating behavioral economic principles. Through partnership with the University of Pennsylvania Health System

(UPHS), we will develop a centralized program of inreach and outreach that includes nudges to clinicians facilitated by the electronic health record (EHR) and direct outreach to patients’ homes. Through these interventions, we will evaluate the effectiveness of offering sequential choice of colonoscopy then FIT

compared to colonoscopy only. Through this intervention, we will include behavioral insights such default options and effort reduction. We will conduct a pragmatic clinical trial with factorial design across 30 primary care practices among 20,000 patients ages 50-72 who are not up-to-date on screening. Practices will be cluster randomized to

colonoscopy only or sequential choice (colonoscopy then FIT) alerts in the EHR (Aim 1). At the same time, patients in all of these practices will be randomized to usual care, direct colonoscopy outreach, and sequential choice outreach of colonoscopy then FIT (Aim 2). Outreach will be provided annually for the 3-year period of

the trial. The primary outcome is adherence to CRC screening. Our hypotheses are that sequential choice will increase adherence to screening, and patient outreach will be superior to EHR nudges alone. We will partner closely with the primary care network at UPHS and leverage the EHR to facilitate the

clinic alerts and patient outreach. Our team includes a team of experienced investigators with expertise in colorectal cancer screening, behavioral economics, health behavior, clinical trials, and health care delivery science. By embedding the project with clinical operations in a pragmatic trial, this approach could be

applicable to other cancer screening and preventive health activities.