Behavioral Economic Approaches for Population-Based Colorectal Cancer Screening

This is a 3-year pragmatic, randomized clinical trial among average-risk patients at diverse primary care practices who are overdue for colorectal (CRC) screening. This project aims to evaluate the effect of a centralized program that includes direct outreach to patients and visit-based, clinician directed nudges facilitated by the electronic health record (EHR) with follow-up text messaging on the uptake of CRC screening. The primary outcome is CRC screening completion at 3 years. Patient and clinician factors impacting the experience and effectiveness of the intervention will be explored through surveys and qualitative interviews.

Inclusion Criteria:Patients ages 50-72Followed by Primary Care with a participating Penn Medicine PCP listed and at least one visit in the last 2 yearsNot up to date on colorectal cancer screening per Health Maintenance (no colonoscopy in the last 10 years, stool testing in the last year, flexible sigmoidoscopy in the last 5 years, MT-sDNA in the last 3 years).Exclusion Criteria:Personal or significant family history of CRC, colonic polyps, hereditary nonpolyposis colorectal cancer syndrome, familial adenomatous polyposis syndrome, other gastrointestinal cancer, gastrointestinal bleeding, iron-deficiency anemia, or inflammatory bowel diseaseHistory of total colectomy, dementia or metastatic cancerCurrently on hospice or receiving palliative careUninsured or self-pay patientsCurrently scheduled for a colonoscopy or sigmoidoscopyActive order for multitarget stool DNA testing (MT-sDNA)History of paraplegia or quadriplegiaElevated chance of mortality within 3 years according to mortality risk algorithm