Could a box on your doorstep prompt more colon cancer screening?

Television ads for Cologuard® promote the ease of fecal
immunochemical test, or FIT kits for colon cancer.

CANCER DIGEST – Mar. 23, 2019 – You may have seen the friendly talking box pitching the simplicity of getting screened for colorectal cancer. "No need for time off for special prep, because I use the DNA in your stool to find colon cancer."

The question researchers at the University of Pennsylvania Medicine wanted to know is if you were just sent the box unsolicited, would you return it? The answer was a surprising 24 percent of people did just that, regardless of incentives to do so.

The experiment was conceived by Shivan Mehta, MD, MBA and Chyke Doubeni, MD, MPH, professors of medicine who were researching behavioral economics with regard to healthcare decision-making. It appears in the Mar. 22, 2019 JAMA Network Open

Most people know that a colonoscopy is the best way to prevent colon cancer, but the screening test is complicated and expensive, not only for the procedure but for patients who have to take a day off from work the colon-cleansing preparation they have to drink and then for the examination itself. Consequently, getting people to screenings has been the biggest hurdle in reducing colorectal cancer rates.

A fecal occult blood test, that examines the DNA in a stool sample for indications of cancer have been shown to be a cost effective, non-invasive alternative for people with average risk of colon cancer. Enter the experiment to simply mail the test to people to see if they would return the kits for analysis.

“We believe that mailing kits directly to patients," the study’s senior author, Doubeni said in a press release, "which frames participation as the default, reduced steps in the screening process, making it easier for patients to get screened and catch colorectal cancer earlier or even potentially prevent it from occurring.”

In the study 900 people ages 50 to 75 who were over due for screening appointments according to their medical records were randomly assigned to receive one of four different packages with the fecal immunochemical test (FIT) kits.

The control group received only the kit, while each of the others had a different financial incentive. One group received a kit and a $10 gift card to a national pharmacy store that was provided regardless of participation. In another group, patients received a FIT kit and the promise of a $10 gift card to the pharmacy if they mailed the completed kit back. The last group were informed that they would be entered into a lottery with a one in 10 chance of winning $100 in cash if they returned the completed kit.

The results showed that about 24 percent of patients mailed back completed kits within two months of receiving them, and 29 percent within six months, which is a relatively high response rate for such a test. The surprising result was that there was no statistical difference in the response rate for the control group with no incentive and the groups that received $10 incentives.

The researchers say the experiment confirms their principles of behavioral economics and are working to apply them in ways to help clinicians increase colorectal screening rates.

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