Financial incentives for promoting colorectal cancer screening: A randomized, comparative effectiveness trial

Samir Gupta, Stacie Miller, Mark Koch, Emily Berry, Paula Anderson, Sandi L. Pruitt, Eric Borton, Amy E. Hughes, Elizabeth Carter, Sylvia Hernandez, Helen Pozos, Ethan A. Halm, Ayelet Gneezy, Alicea J. Lieberman, Celette Sugg Skinner, Keith Argenbright, Bijal Balasubramanian

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

OBJECTIVES:Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.METHODS:We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.RESULTS:FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.CONCLUSIONS:Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

Original languageEnglish (US)
Pages (from-to)1630-1636
Number of pages7
JournalAmerican Journal of Gastroenterology
Volume111
Issue number11
DOIs
StatePublished - Nov 1 2016

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Early Detection of Cancer
Motivation
Colorectal Neoplasms
Poverty
Vulnerable Populations
Colonoscopy
Primary Health Care
Safety
Health

ASJC Scopus subject areas

  • Gastroenterology

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Financial incentives for promoting colorectal cancer screening : A randomized, comparative effectiveness trial. / Gupta, Samir; Miller, Stacie; Koch, Mark; Berry, Emily; Anderson, Paula; Pruitt, Sandi L.; Borton, Eric; Hughes, Amy E.; Carter, Elizabeth; Hernandez, Sylvia; Pozos, Helen; Halm, Ethan A.; Gneezy, Ayelet; Lieberman, Alicea J.; Sugg Skinner, Celette; Argenbright, Keith; Balasubramanian, Bijal.

In: American Journal of Gastroenterology, Vol. 111, No. 11, 01.11.2016, p. 1630-1636.

Research output: Contribution to journalArticle

Gupta, S, Miller, S, Koch, M, Berry, E, Anderson, P, Pruitt, SL, Borton, E, Hughes, AE, Carter, E, Hernandez, S, Pozos, H, Halm, EA, Gneezy, A, Lieberman, AJ, Sugg Skinner, C, Argenbright, K & Balasubramanian, B 2016, 'Financial incentives for promoting colorectal cancer screening: A randomized, comparative effectiveness trial', American Journal of Gastroenterology, vol. 111, no. 11, pp. 1630-1636. https://doi.org/10.1038/ajg.2016.286
Gupta, Samir ; Miller, Stacie ; Koch, Mark ; Berry, Emily ; Anderson, Paula ; Pruitt, Sandi L. ; Borton, Eric ; Hughes, Amy E. ; Carter, Elizabeth ; Hernandez, Sylvia ; Pozos, Helen ; Halm, Ethan A. ; Gneezy, Ayelet ; Lieberman, Alicea J. ; Sugg Skinner, Celette ; Argenbright, Keith ; Balasubramanian, Bijal. / Financial incentives for promoting colorectal cancer screening : A randomized, comparative effectiveness trial. In: American Journal of Gastroenterology. 2016 ; Vol. 111, No. 11. pp. 1630-1636.
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abstract = "OBJECTIVES:Offering financial incentives to promote or {"}nudge{"} participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.METHODS:We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.RESULTS:FIT completion was 36.9{\%} with vs. 36.2{\%} without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6{\%}, P=0.32 vs. no incentive) or $5 incentive (39.2{\%}, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.CONCLUSIONS:Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.",
author = "Samir Gupta and Stacie Miller and Mark Koch and Emily Berry and Paula Anderson and Pruitt, {Sandi L.} and Eric Borton and Hughes, {Amy E.} and Elizabeth Carter and Sylvia Hernandez and Helen Pozos and Halm, {Ethan A.} and Ayelet Gneezy and Lieberman, {Alicea J.} and {Sugg Skinner}, Celette and Keith Argenbright and Bijal Balasubramanian",
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T2 - A randomized, comparative effectiveness trial

AU - Gupta, Samir

AU - Miller, Stacie

AU - Koch, Mark

AU - Berry, Emily

AU - Anderson, Paula

AU - Pruitt, Sandi L.

AU - Borton, Eric

AU - Hughes, Amy E.

AU - Carter, Elizabeth

AU - Hernandez, Sylvia

AU - Pozos, Helen

AU - Halm, Ethan A.

AU - Gneezy, Ayelet

AU - Lieberman, Alicea J.

AU - Sugg Skinner, Celette

AU - Argenbright, Keith

AU - Balasubramanian, Bijal

PY - 2016/11/1

Y1 - 2016/11/1

N2 - OBJECTIVES:Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.METHODS:We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.RESULTS:FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.CONCLUSIONS:Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

AB - OBJECTIVES:Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.METHODS:We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.RESULTS:FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.CONCLUSIONS:Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.

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