Researchers from the Perelman School of Medicine at the University of Pennsylvania have a new strategy to promoting colorectal cancer screenings. Partnering with a community health clinic, they exchanged the standard practice of sending a text message reminding patients to pursue screening for a default mailed-straight-to-your-home test kit (known as a fecal immunochemical test, or FIT) for those overdue for screening. The research takes a psychological approach, making it so that people actually have to opt-out of receiving an at-home test in order to avoid receiving one. The researchers say that this approach correlated with a more than 1,000% jump in screening rates.
The clinic that the researchers collaborated with primarily serves people of color. Shivan Mehta, MD, who is associate chief innovation officer at Penn Medicine as well as an assistant professor of Medicine, explains: "Colorectal cancer screening rates remain limited in underserved populations, which includes those in the clinic we partnered with. We saw that there is an opportunity to use text messaging and new insights from behavioral science to increase uptake."
Their findings, published in the Journal of General Internal Medicine, have significant implications for fighting the racial disparities that are prevalent in colorectal cancer incidences. Previous research has shown that the number of deaths from colorectal cancer among Black people is 40% higher than in white people, and 100% higher than in Asian/Pacific Islanders. This may in large part be due to low screening rates in certain demographics.
Past studies have also shown that people are more likely to complete a FIT kit screening than the traditional colonoscopy, likely because of the ease and convenience of conducting the test in one’s own home. Watch the video below to learn about how a fecal immunochemical test works.
The study, led by Mehta and first author Sarah Huf, MBBS, relied heavily on behavioral science to influence participants. Of the 400 participants, 90% of whom were Black and half of whom were on Medicaid, 200 received a single reminder text to alert for overdue screening while the other 200 individuals received FIT kits (unless they had opted out) and three text message reminders to return the tests. The results showed that only 2% of individuals in the first group completed the FIT kit, while 20% of the second group had completed it.
The researchers say that their investigations imply the potential for such behavioral science approach. "It is important to note that this is a population at a community health center that may not routinely seek out medical care, especially preventive care, so there is a low baseline screening rate," Huf added. "Future interventions may need to address issues such as reading comprehension and not having a stable place to live." Mehta notes that cost is also an important factor: "For these types of health clinics, minimizing cost is critical for sustainability since they have many competing health priorities for their patients," he concluded.