EHR-Nudges for Breast Cancer Screening

(I-SCREEN Rep Trial)

Overseen By Amol Navathe, MD, PhD

Age: 18+

Sex: Female

Trial Phase: Academic

Sponsor: Abramson Cancer Center at Penn Medicine

Disqualifiers: Bilateral mastectomy, Breast cancer, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to boost breast cancer screening rates by sending personalized reminders to both patients and doctors. The study tests various combinations of text message reminders and electronic health record (EHR) alerts to assist women in scheduling their mammograms. Women aged 40 to 74 who have a primary care visit at Lancaster General Health and are overdue for a mammogram qualify as good candidates for this trial. Participants may receive nudges before and after their visit to encourage them to complete their screenings.

As an unphased trial, this study offers participants the chance to contribute to innovative strategies that could improve health outcomes for many women.

Do I need to stop my current medications for this trial?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on increasing breast cancer screening rates rather than medication changes.

What prior data suggests that these nudges are safe for increasing breast cancer screening rates?

Research shows that using text messages as reminders for breast cancer screenings is safe and well-received. Studies have found that these messages, which are simply reminders sent to phones, do not cause any physical harm. They have effectively increased the number of people scheduling mammograms by providing timely reminders.

Text messages offer a common and low-risk way to help patients maintain their health check-ups. No reports of negative effects from receiving these messages have emerged. Designed to support health, they encourage timely screenings, which are crucial for early detection and better health outcomes.

Overall, using text messages as reminders has proven to be a safe and effective strategy in healthcare. Various studies have tested this method, and no safety concerns have been reported. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the EHR-Nudges for Breast Cancer Screening trial because it explores innovative ways to encourage timely screenings using personalized text message reminders and smart data elements. Unlike traditional methods that rely on healthcare providers to remind patients, these interventions use digital nudges to proactively engage patients both before and after their visits. The pre-visit and post-visit text messages, combined with smart data insights, aim to seamlessly integrate into patients' lives, making it easier for them to prioritize their health. The trial seeks to determine if these digital nudges can improve screening rates, offering a potentially cost-effective and scalable solution to enhance preventive care.

What evidence suggests that these nudges are effective for increasing breast cancer screening rates?

Research has shown that text message reminders can significantly increase attendance at breast cancer screenings. In this trial, participants may receive various types of text message nudges. For instance, one study found that a pre-visit text message increased attendance at breast screening appointments. Another study highlighted that pre-visit text reminders helped patients remember to schedule their mammograms. Participants in this trial may also receive post-visit text messages. Evidence from Penn Medicine suggests these messages successfully encouraged more women to return for routine mammograms after the pandemic. Overall, these methods have effectively improved breast cancer screening rates. ^{1 2 3 6 7}

Who Is on the Research Team?

Amol Navathe, MD, PhD

Principal Investigator

University of Pennsylvania

Are You a Good Fit for This Trial?

This trial is for women who are due for breast cancer screening according to USPSTF guidelines and have an upcoming primary care visit. It's not specified who can't join, so it seems open to all eligible women at the participating health system.

Inclusion Criteria

A scheduled new or return (non-urgent/sick) primary care visit at one of the study practices at Lancaster General Health

I am a woman aged between 40 and 74.

I do not have a mammogram scheduled in the future.

Exclusion Criteria

Have no phone number (home or mobile) listed in their chart

Have a mammogram exclusion modifier in Health Maintenance

I have had a bilateral mastectomy, breast cancer, or cancer that has spread.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Intervention

Participants receive personalized nudges to increase breast cancer screening rates

6 months

Ongoing interactions via text messages and EHR nudges

Follow-up

Participants are monitored for completion of screening mammograms

3 months

What Are the Treatments Tested in This Trial?

Interventions

• Post-Visit Patient Text Messages
• Pre-Visit Patient Text Message
• Smart Data Element (SDE)

Trial Overview The study tests if reminders (nudges) to both doctors and patients can increase breast cancer screenings. Patients get text messages before and after doctor visits, while doctors see a reminder in their electronic records.

How Is the Trial Designed?

Group I: Pre-Visit Text Message/Smart Data Element Only Experimental Treatment 2 Interventions

Patients randomized to this arm will receive the pre-visit text message and Smart Data Element nudges.

Group II: Pre-Visit Text Message/Smart Data Element + Post-Visit Text Message Experimental Treatment 3 Interventions

Patients randomized to this arm will be eligible to receive both the pre- and post-visit text messages and the Smart Data Element nudges.

Group III: Post-Visit Text Message Only Experimental Treatment 1 Intervention

Patients randomized to this arm will be eligible to receive the post-visit text message nudges.

Group IV: Standard of Care Active Control 1 Intervention

Patients randomized to the standard of care arm will receive no nudge interventions.

Who Is Running the Clinical Trial?

Abramson Cancer Center at Penn Medicine

Lead Sponsor

Trials

425

Recruited

464,000+

National Institute on Aging (NIA)

Collaborator

Trials

1,841

Recruited

28,150,000+

Citations

1. journals.plos.org journals.plos.org/plosone/article?id=10.1371/journal.pone.0306720

The use of text messages as an alternative invitation method ... This study aimed to determine whether a text message is as good as a postal letter as an invitation method for previous screenees in a breast cancer screening ...

2. publichealth.jmir.org publichealth.jmir.org/2024/1/e57959

Effectiveness and Acceptability of Targeted Text Message ... SMS text message reminders have shown effectiveness in increasing mammography attendance in breast cancer screening and the European ...

3. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC5590008/

Text Messaging Interventions on Cancer Screening Rates Text messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer ...

4. jamanetwork.com jamanetwork.com/journals/jamainternalmedicine/fullarticle/2818196

Behavioral Interventions to Improve Breast Cancer ... In these trials, we found that bulk ordering and text messaging significantly increased patient response to breast cancer screening outreach.

5. pennmedicine.org pennmedicine.org/News/how-invitations-brought-mammogram-rates-up

'Invitations' from Penn Medicine restored mammogram rates A Penn Medicine team used text messages and default orders to bring more patients back to receiving routine mammograms after a pandemic pause.

6. clinicaltrials.gov clinicaltrials.gov/study/NCT02872363

Does the Wording of Text Message Reminders Improve ... The premise of the study is whether a subtle change in a text message can increase the number of patients attending their breast screening appointment. A pre- ...

7. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC8428506/

Supporting breast cancer survivors via text messages This study aims to evaluate the reach, usefulness, acceptability, and factors influencing engagement with a lifestyle-focused text message intervention.