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

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if a special pamphlet can encourage more people to complete their colon cancer screening using the FIT test, which checks for hidden blood in stool. The trial will evaluate different pamphlet versions, including one with a social norm driver—a behavioral nudge—showing how the clinic's screening rates compare to state and national goals. Ideal participants are patients aged 45-75 who visit Bellevue Ambulatory Care Resident Clinic, have not completed a FIT test in the past year, and can read English or Spanish. As an unphased trial, this study allows participants to contribute to innovative strategies that may enhance public health screening practices.

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 prior data suggests that this behavioral nudge is safe for increasing colon cancer screening rates?

Research has shown that using educational pamphlets and messages about social norms is generally safe. These methods have been tested in various situations to improve health habits, such as increasing cancer screening participation. Without physical treatment, the risk of side effects remains low. People have used these educational tools without encountering serious problems. The pamphlet provides clear information, while the social norm message encourages participation by highlighting others' actions. These tools are well-received and focus on providing information rather than medical treatment. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about this trial because it explores new ways to boost colon cancer screening rates, which is crucial for early detection and treatment. Unlike the traditional method of simply handing out a FIT kit, this trial tests the impact of adding an informative pamphlet and a social norm driver. The pamphlet simplifies the screening process with clear instructions and emphasizes its importance, potentially increasing compliance. The social norm driver uniquely motivates patients by showing how the clinic’s screening rates stack up against state and national goals, encouraging participation through a sense of collective responsibility. This approach could significantly improve screening rates by appealing to patients' understanding and community involvement.

What evidence suggests that this behavioral nudge is effective for increasing colon cancer screening rates?

Research has shown that social norms can increase the number of people who complete health screenings, such as the fecal immunochemical test (FIT) for colorectal cancer. In this trial, participants in the "Time Period 3" arm will receive a pamphlet that uses this concept by displaying the clinic's screening rate alongside state and national goals, motivating individuals to complete their tests. Additionally, participants in the "Time Period 2" and "Time Period 3" arms will receive pamphlets with clear instructions and emphasize the importance of FIT screening to help overcome obstacles and boost participation. Overall, these strategies aim to encourage more people to complete their colorectal cancer screenings. ^{6 7 8 9 10}

Who Is on the Research Team?

Aasma Shaukat, MD

Principal Investigator

NYU Langone Health

Are You a Good Fit for This Trial?

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 for a Trial Participant

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

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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]

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 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]

Citations

1.

pubmed.ncbi.nlm.nih.gov

pubmed.ncbi.nlm.nih.gov/39746817/

Colorectal Cancer Screening and Social Needs

Respondents with financial strain, social isolation, and food insecurity had lower odds of being up to date with CRC screening.

2.

sciencedirect.com

sciencedirect.com/science/article/pii/S2211335523002449

Barriers and facilitators of colorectal cancer screening ...

Despite clear evidence that regular screening reduces colorectal cancer (CRC) mortality and the availability of multiple effective screening options, CRC ...

3.

jabfm.org

jabfm.org/content/early/2025/10/03/jabfm.2024.240424R1/tab-figures-data

Shared Decision Making in Colorectal Cancer Screening

Survey to examine the correlations between family support and influence, cultural identity, CRC beliefs, and their relationship to an informed decision about ...

4.

frontiersin.org

frontiersin.org/journals/behavioral-economics/articles/10.3389/frbhe.2025.1566172/full

The impact of dynamic social norms messages on ...

In this study, we aimed to determine if dynamic social norms could increase the intention to complete a FIT, a non-invasive screening test ...

5.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC7846969/

Framework and Strategies to Eliminate Disparities in ...

This paper summarizes the evidence on disparities in CRC health outcomes and discusses a health equity framework to guide the use of evidence-based ...

6.

gi.org

gi.org/education/educating-you-your-colleagues/colorectal-cancer-awareness-education-resources/crc-community-education-toolkit/

Colorectal Cancer (CRC) Community Education Toolkit

Colorectal Cancer screening is essential and should not be delayed. Colorectal Cancer is one of the most preventable types of cancer. Based on evidence-based ...

7.

coloncancercoalition.org

coloncancercoalition.org/resources/educational-materials/

Educational Materials

A longer version of the popular informational 4×6 card, this flyer walks patients through colorectal cancer screening guidelines, screening options, and signs ...

8.

cancer.org

cancer.org/health-care-professionals/american-cancer-society-prevention-early-detection-guidelines/colorectal-cancer-screening-guidelines.html

Colorectal Cancer Screening Guidelines

The American Cancer Society 2018 guideline for colorectal cancer screening recommends that average-risk adults aged 45 years and older undergo regular screening ...

9.

cdc.gov

cdc.gov/colorectal-cancer/resources/index.html

Colorectal Cancer Communication Resources

CDC offers resources to help you learn about the importance of men and women 45 years old or older getting screened for colorectal (colon) cancer regularly.

10.

pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC4822700/

E-mail to Promote Colorectal Cancer Screening Within Social ...

Peer modeling and communication of subjective norms among family and friends have been shown to influence CRC screening rates, particularly in minority and ...