Behavioral Nudge for Increasing Colon Cancer Screening Rates

Overseen By Tianbo Jiang

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: NYU Langone Health

Disqualifiers: Outside age range, Other clinics, Others

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

Compensation: Varies

Number of Visits: 3

600 Participants Needed

Trial Summary

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on increasing colon cancer screening rates, so it's unlikely that your medications will be affected.

What data supports the effectiveness of the treatment Information pamphlet + social norm driver for increasing colon cancer screening rates?

Research shows that using social norm messages, which inform people about the behavior of others, can increase participation in colorectal cancer screening programs. For example, a study found that adding messages about social norms to invitation letters increased screening rates among people who previously did not respond. ^{1 2 3 4 5}

Is the behavioral nudge for increasing colon cancer screening safe for humans?

The research does not provide specific safety data for the behavioral nudge intervention, but it generally involves providing information and messages to encourage screening, which is unlikely to pose direct safety risks to participants. ^{1 2 6 7 8}

How does the treatment 'Information pamphlet + social norm driver' for increasing colon cancer screening rates differ from other treatments?

This treatment is unique because it uses behavioral nudges, like social norms, to encourage people to get screened for colon cancer. Unlike traditional methods that might rely on medical interventions or financial incentives, this approach focuses on changing behavior by informing individuals about what others are doing, which can motivate them to participate in screening. ^{1 2 3 9 10}

What is the purpose of this trial?

The purpose of this study is to evaluate if a behavioral nudge principle known as social norm driver can be implemented to improve fecal immunochemical test (FIT) completion rates for patients' age 45-75 years old due for colorectal cancer screening at Bellevue Hospital Medicine Ambulatory Care Clinic. The study's endpoints include FIT screening completion rate and timeliness. Secondary analysis will look at demographic information such as age group, gender, prior screening, number of prior visits at the clinic.

Research Team

Aasma Shaukat, MD

Principal Investigator

NYU Langone Health

Eligibility Criteria

This trial is for individuals aged 45-75 who are due for colorectal cancer screening at Bellevue Hospital Medicine Ambulatory Care Clinic. Details like age, gender, previous screenings, and clinic visits may influence participation.

Inclusion Criteria

I visited the Bellevue Clinic between Jan and July 2024 and am between 45-75 years old.

I am 45-75, haven't had a FIT test in a year, can read English or Spanish, and can consent.

I am 45-75, haven't had a FIT test in a year, can read English or Spanish, and can consent.

Exclusion Criteria

I am not 45-75 years old, had a FIT test this year, and cannot read English or Spanish.

I am not between 45-75 years old and do not attend Bellevue Ambulatory Care Resident Clinic.

I am not between 45-75, had a FIT test this year, and can't read English or Spanish.

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Time Period 1

A FIT test is ordered by the provider and a patient care assistant gives the patient a FIT kit at the end of the visit.

1 visit

1 visit (in-person)

Time Period 2

Participants receive a new information pamphlet alongside the FIT kit at the end of the visit.

1 visit

1 visit (in-person)

Time Period 3

Participants receive a new information pamphlet with a social norm driver alongside the FIT kit.

1 visit

1 visit (in-person)

Follow-up

Participants are monitored for completion of their FIT screening test up until 3 months after the initial stool study was given.

3 months

Treatment Details

Interventions

• Information pamphlet + social norm driver

Trial Overview The study tests if a 'social norm driver'—a type of behavioral nudge when added to an information pamphlet—increases the rate and speed at which people complete fecal immunochemical tests (FIT) for colon cancer screening.

Participant Groups

Group I: Time Period 3 Experimental Treatment 1 Intervention

A new information pamphlet is given to participants along the FIT kit similar to "Time period 2", but includes a social norm driver in the pamphlet that displays the sub-par screening rate of our clinic compared to a collective New York State screening rate and a national screening rate goal set by the Centers for Disease Control and Prevention (CDC).

Group II: Time Period 2 Experimental Treatment 1 Intervention

A new information pamphlet is given to participants alongside the FIT kit at the end of the visit. The pamphlet contains an easy-to-read description of FIT screening adapted from the NYC department of health C5 Colorectal cancer (CRC) screening coalition pamphlet and lead-time CRC screening messaging tool, instructions on how to complete the test and the importance of FIT screening.

Group III: Time Period 1 Active Control 1 Intervention

A FIT test is ordered by the provider and a patient care assistant (PCA) gives patient a FIT kit, which includes a specimen cup and instructions on how to use it, at the end of the visit prior to their departure.

Who Is Running the Clinical Trial?

NYU Langone Health

Lead Sponsor

Trials

1,431

Recruited

838,000+

Findings from Research

Displaying traffic fatality counts on highway signs as part of a safety campaign led to an increase in crashes during the campaign weeks, suggesting that the intervention may have unintended negative effects.

The negative impact of this campaign did not persist beyond the weeks it was active, indicating that overly attention-grabbing interventions can distract from safe driving behaviors rather than promote them.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Can behavioral interventions be too salient? Evidence from traffic safety messages. Hall, JD., Madsen, JM.[2022]

In a pilot study with 213 primary care patients, providing quantitative information about colorectal cancer screening significantly increased the likelihood of patients getting screened compared to those who did not receive this information.

While a nudge towards stool testing (FIT) increased perceived risk of colorectal cancer, it did not lead to a higher screening uptake, suggesting that simply nudging patients may not be as effective as providing clear quantitative data.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial. Schwartz, PH., Perkins, SM., Schmidt, KK., et al.[2018]

In a study involving 88 early childhood education centers, incorporating nudge strategies into workshop invitations did not significantly increase registration rates compared to generic invitations, with only 25% of the intervention group registering versus 20% in the control group.

The study found no significant differences in invitation recall or acceptability between the two groups, suggesting that low-intensity behavioral nudges may not be effective in promoting participation in nutrition education workshops.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of Nudge Strategies on Nutrition Education Participation in Child Care: Randomized Controlled Trial. Grady, A., Barnes, C., Lum, M., et al.[2021]

References

1. United States pubmed.ncbi.nlm.nih.gov

Effect of Behavioral Economic Incentives for Colorectal Cancer Screening in a Randomized Trial. [2022]

2. United States pubmed.ncbi.nlm.nih.gov

Testing behavioral economics messages to increase non-responders' participation in organized colorectal cancer-screening programs: A randomized controlled trial. [2023]

3. United States pubmed.ncbi.nlm.nih.gov

Active Choice and Financial Incentives to Increase Rates of Screening Colonoscopy-A Randomized Controlled Trial. [2018]

4. United States pubmed.ncbi.nlm.nih.gov

Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial. [2018]

5. United States pubmed.ncbi.nlm.nih.gov

Behavioral economics: "nudging" underserved populations to be screened for cancer. [2018]

6. England pubmed.ncbi.nlm.nih.gov

Hospital doctors' attitudes to brief educational messages that aim to modify diagnostic test requests: a qualitative study. [2020]

7. United States pubmed.ncbi.nlm.nih.gov

Can behavioral interventions be too salient? Evidence from traffic safety messages. [2022]

8. United States pubmed.ncbi.nlm.nih.gov

Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial. [2018]

9. United States pubmed.ncbi.nlm.nih.gov

Impact of Nudge Strategies on Nutrition Education Participation in Child Care: Randomized Controlled Trial. [2021]

10. England pubmed.ncbi.nlm.nih.gov

The effect of deadlines on cancer screening completion: a randomized controlled trial. [2021]