Behavioral Economic Approaches for Population-based Colorectal Cancer Screening

基于人群的结直肠癌筛查的行为经济学方法

• 批准号: 10365418
• 负责人: Shivan Jatin Mehta
• 金额: $ 67.26万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-17 至 2026-11-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10365418
• 关键词: Address; Architecture; Behavior; Cancer Etiology; Caring; Cessation of life; Clinic Visits; Colonoscopy; Colorectal Cancer; Dimensions; Early Diagnosis; Effectiveness; Effectiveness of Interventions; Electronic Health Record; Fatigue; Friction; Goals; Guidelines; Health; Health Promotion; Health system; Home; Human; Individual; Industry; Intervention; Interview; Medical; Methods; Office Visits; Patients; Pennsylvania; Policies; Pragmatic clinical trial; Prevention; Prevention strategy; Preventive; Primary Health Care; Procedures; Process; Randomized; Risk; Surveys; System; Test Result; Testing; Time; United States; Universities; Visit; Work; behavioral economics; care providers; colorectal cancer screening; design; effectiveness evaluation; ethnic minority; evidence base; health care delivery; insight; member; outreach; patient outreach; population based; pragmatic trial; primary outcome; programs; provider factors; racial and ethnic disparities; racial minority; routine care; screening; screening program; shared decision making; uptake

PROJECT SUMMARY/ ABSTRACT Despite effective strategies for prevention, early detection, and treatment, colorectal cancer (CRC) remains the second leading cause of cancer death in the United States. While there have been considerable policy and system-level efforts to increase CRC screening rates, uptake remains well below national goals of 80% participation, and racial/ethnic disparities remain. Colonoscopy and FIT are considered evidence-based and top-tier tests for CRC screening, but most screening programs rely heavily on one of these tests. The overall goal of this proposal is to evaluate a multi-level intervention that could durably increase CRC screening rates by incorporating principles of behavioral economics, such as opt-out framing, simplifying choice, and effort reduction. Through partnership with the University of Pennsylvania Health System (UPHS), we will develop a centralized program that includes clinician-directed nudges facilitated by the electronic health record (EHR) and direct outreach to patients. We will also evaluate the effectiveness of sequential choice (colonoscopy, then FIT to those who defer or decline) compared to offering colonoscopy only. This is a 3-year pragmatic clinical trial with 2 x 3 factorial design at 30 diverse primary care practices with 20,000 average-risk patients who are overdue for screening. Clinicians will be cluster randomized in a 1:1 ratio (at the practice level) to A) colonoscopy only, or B) sequential choice (colonoscopy, then FIT if no colonoscopy is completed) nudges in the EHR during clinic visits (Aim 1). Concurrently, patients will be individually randomized in a 1:2:2 ratio to 1) no outreach, 2) colonoscopy only, or 3) sequential choice outreach of colonoscopy, then FIT (Aim 2). The primary outcome is completion of guideline-recommended colorectal cancer screening. Through surveys and qualitative interviews, we will explore patient and clinician factors impacting the effectiveness of the intervention.

项目摘要/摘要 尽管采取了有效的预防、早期发现和治疗策略，但结直肠癌(CRC) 仍然是美国癌症死亡的第二大原因。虽然已经有了相当多的 政策和系统层面努力提高结直肠癌筛查率，接种率仍远低于国家目标 80%的参与率，种族/族裔差距依然存在。结肠镜检查和FIT被认为是基于证据的 和用于结直肠癌筛查的顶级测试，但大多数筛查项目严重依赖其中一种测试。 这项提案的总体目标是评估可持续增加的多层次干预 结直肠癌筛查率纳入行为经济学原理，如选择退出框架，简化 选择，减少努力。通过与宾夕法尼亚大学卫生系统(UPHS)合作， 我们将开发一个集中计划，其中包括由电子医疗促进的临床医生指导的推送 记录(EHR)和直接接触病人。我们还将评估序贯选择的有效性 (结肠镜检查，然后适合那些推迟或拒绝的人)与只提供结肠镜检查相比。 这是一项为期3年的实用临床试验，采用2×3析因设计，涉及30种不同的初级保健实践。 有20,000名中危患者逾期进行筛查。临床医生将按1：1随机分组 (在实践层面)与A)仅结肠镜检查的比率，或B)顺序选择(结肠镜检查，如果没有，则符合 结肠镜检查完成)在临床就诊期间轻推EHR(目标1)。同时，患者将被 按1：2：2的比例随机分为1)无外展、2)仅结肠镜检查或3)顺序选择外展 结肠镜检查，然后FIT(目标2)。主要结果是完成指南建议的结直肠 癌症筛查。通过调查和定性访谈，我们将探讨患者和临床医生的因素 影响干预的有效性。