Behavioral Economics and Population-based Colorectal Cancer Screening

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PROJECT SUMMARY/ ABSTRACT This proposal describes a 5-year comprehensive program of training and mentored research for an academic career in health care delivery research. I am an Assistant Professor of Medicine and Health Policy at the University of Pennsylvania. My goal is to become an independent investigator evaluating how health systems can leverage new insights from social science to improve access to and quality of colorectal cancer (CRC) screening. While I have a strong background in clinical gastroenterology and retrospective health services research, I will receive additional didactic and experiential training in qualitative research, methodological issues of clinical trials, and implementation science. At the University of Pennsylvania, I will take advantage of an experienced mentorship team, close partnership with the health care delivery system, and expertise in behavioral economics and consumer marketing across the Perelman School of Medicine and the Wharton School. CRC is the second leading cause of cancer death in the United States. Despite effective strategies for prevention, early detection, and treatment, and aggressive public health efforts to promote screening, national rates are limited at 62-65% The US currently relies predominantly on primary care providers to recommend screening to those who attend an office visit. There have been efforts to create proactive and organized CRC screening programs, but they have not been broadly adopted. I will collaborate with the primary care service line at the University of Pennsylvania Health System, an academic health system with 65 diverse primary care practices within the largest health system in Eastern Pennsylvania and New Jersey. I will conduct an iterative pilot of a proactive process to send colonoscopy preparation kits to eligible patients as a way to facilitate CRC screening participation (Aim 1). Then, I will conduct a 3-arm pragmatic RCT among 1182 eligible patients to evaluate if alternative ways of offering the colonoscopy preparation kit can increase response rates (Aim 2). The preparation kit is a form of a financial incentive that invokes norms of reciprocity, frames participation as the default, creates an endowment, and reduces the burden of patient effort. Finally, I will perform qualitative interviews with patients and practices to understand their experience with CRC screening outreach and develop refined and new approaches (Aim 3). This work will provide me with skills and preliminary data to apply for external funding to support a pragmatic trial evaluating a multi-level approach to population-based CRC screening. At the conclusion of this award, I will receive rigorous research training to complement existing skills, I will complete a project applying principles of behavioral economics and consumer marketing to CRC screening, and I will submit a competitive application for an R-level award to fund a trial evaluating the implementation of a state-of-the-science approach to CRC screening outreach.