"Colorectal cancer screening rates remain limited in underserved populations, which includes those in the clinic we partnered with," Shivan Mehta, MD, associate chief innovation officer at Penn Medicine and an assistant professor of Medicine. "We saw that there is an opportunity to use text messaging and new insights from behavioral science to increase uptake."
One method consistently used to boost screenings is the fecal immunochemical test (FIT). These kits just require a stool sample from a patient - which can be provided at home - that are then returned to a laboratory by mail and analyzed for the trace blood associated with colorectal cancer. While a colonoscopy remains the gold standard because it is the most thorough check and only needs to be completed once every 10 years, FIT kits are much easier for patients to handle and likely to be completed, even though they only clear a patient for a year.
Looking to increase low completion rates, the researchers - led by Mehta and the study's first author, Sarah Huf, MBBS, a former Commonwealth Fund Fellow at Penn and now an Honorary Clinical Lecturer at Imperial College London - decided to focus on completing FIT kits. As such, they randomly split a group of more than 400 patients overdue for screenings into two equal arms: one that just received a single reminder text and another that received FIT kits unless patients sent a response to an introduction text to say that they did not want them. Almost 90 percent of these patients were Black, and half were Medicaid beneficiaries.
From March to May 2018, these patients were enrolled to either receive the reminder text (the control group) or to receive the FIT kit pending an opt-out (the intervention group). The latter group also received up to three follow-up texts with messages based on proven behavioral science techniques to nudge them into returning the kits.
By the end of the period studied (12 weeks from when each patient received their first text message) a little more than 2 percent of the patients in the control group had completed a FIT kit or had a colonoscopy. But for the intervention arm of the study, nearly 20 percent had done the same.
When looking purely at FIT kit return rates, the intervention arm increased by more than 17 percentage points. In the control, it was less than two. And while screening rates did remain relatively low, the improvement showed great promise for the population served.
MEDICA-tradefair.com; Source: University of Pennsylvania School of Medicine
