Improving the Message of Mailed Outreach Improves CRC Screening Adherence
Douglas K. Rex, MD, FASGE, reviewing Bakr O, et al. Clin Transl Gastroenterol 2020 Jan.
Mailed outreach, in which a fecal immunochemical test (FIT) kit is sent directly to eligible patients, is increasingly recognized as a measure that improves colorectal cancer (CRC) screening adherence. This study was a randomized trial that incorporated principles of behavioral economics and social psychology to make a more persuasive message in the mailed outreach.
In a randomized design, the usual care group got the mailed FIT kit and a letter describing features such as “colon cancer is the second most common cancer in the U.S.,” “screening is recommended every 1 to 10 years beginning at age 50,” “we have enclosed the FIT kit,” and “there are several options for screening.”
The intervention group also received a FIT kit and letter, but text was minimized, images offering colonoscopy and FIT were included, and messaging was revised to leverage behavioral economics and social psychology principles as follows:
- Choice overload (reduced the number of available tests to 2 to avoid choice overload): “You have options. You can be screened at the office with a colonoscopy or at home with your FIT kit.”
- Salient costs and benefits (identified specific patient benefits of choosing an option): “Screening takes minutes at home” and “Screening that could save your life.”
- Implied scarcity (inferred higher value): “You have been selected to complete a colon cancer screening that could save your life.”
- Psychological ownership (fostered responsibility): “Your kit can detect signs of colon cancer.”
- Defaults (provided an option if an active choice was not made): “Please return the included kit in the next 2 weeks.”
At 6 months, uptake was 19.5% in the usual care arm and 24.1% in the intervention arm (P=.02), or nearly a 25% increase in uptake. All the increase occurred in FIT uptake.
COMMENT
These data indicate that using principles of behavioral economics and social psychology improves uptake in a mailed outreach FIT program. Gastroenterologists developing organized screening programs should incorporate these messaging concepts.
Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.
![d-rex](https://www.endoscopy-campus.com/wp-content/uploads/d-rex.jpg)
Douglas K. Rex, MD, FASGE
CITATION(S)
Bakr O, Afsar-Manesh N, Raja N, et al. Application of behavioral economics principles improves participation in mailed outreach for colorectal cancer screening. Clin Transl Gastroenterol 2020;11:e00115. (https://doi.org/10.14309/ctg.0000000000000115)