Colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women in the U.S. It is recommended that individuals begin regular screenings for CRC at the age of 50. Screening can prevent cancer by discovering precancerous polyps that can be removed before they turn into cancer. It can also find CRC early when treatment can often lead to a cure. Patients have several options when it comes to completing screening. The most common are colonoscopy and fecal immunochemical test (FIT).
Unfortunately, millions of people in the U.S. are not getting screened for CRC.
We have run a series of pilots to identify strategies to improve CRC screening rates. To hone in on what might move the needle, we’ve tested behavioral economic approaches such as active choice, opt-out nudges, and incentives, experimented with how outreach and communication modalities are used, and explored which types of screening patients are most amenable to completing.
Key findings to date include the following:
A bidirectional, automated texting navigation program improved colonoscopy adherence rates as compared with usual care. Learn more.
The addition of a lottery-based incentive to a text messaging program that asks patients to opt-in to receive mailed FIT screening did not improve completion rates. Learn more.
Mailed CRC screening outreach providing an option to opt‐out had significantly higher participation rates than opt‐in messaging. Learn more.
Offering the choice of FIT reduced colonoscopy selection, and active choice resulted in an even lower colonoscopy rate compared with a sequential choice or colonoscopy alone. Learn more.
We’re currently scaling up our automated text navigation program to help patients through the colonoscopy preparation process. We’re also expanding outreach efforts - taking key findings and broadening our reach to other preventive health areas, including hepatitis C screening and hepatocellular carcinoma surveillance.
COVID-19 resulted in about a 90 percent decrease in CRC screening during the initial surge. Since then, our work on mailed outreach that does not require an in-person office visit has been utilized across the health system to increase screening rates.