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A randomized trial of mailed outreach with behavioral economic interventions to improve liver cancer surveillance.


ABSTRACT:

Background

Surveillance rates for HCC remain limited in patients with cirrhosis. We evaluated whether opt-out mailed outreach increased uptake with or without a $20 unconditional incentive.

Methods

This was a pragmatic randomized controlled trial in an urban academic health system including adult patients with cirrhosis or advanced fibrosis, at least 1 visit to a specialty practice in the past 2 years and no surveillance in the last 7 months. Patients were randomized in a 1:2:2 ratio to (1) usual care, (2) a mailed letter with a signed order for an ultrasound, or (3) a mailed letter with an order and a $20 unconditional incentive. The main outcome was the proportion with completion of ultrasound within 6 months.

Results

Among the 562 patients included, the mean age was 62.1 (SD 11.1); 56.8% were male, 51.1% had Medicare, and 40.6% were Black. At 6 months, 27.6% (95% CI: 19.5-35.7) completed ultrasound in the Usual care arm, 54.5% (95% CI: 47.9-61.0) in the Letter + Order arm, and 54.1% (95% CI: 47.5-60.6) in the Letter + Order + Incentive arm. There was a significant increase in the Letter + Order arm compared to Usual care (absolute difference of 26.9%; 95% CI: 16.5-37.3; p<0.001), but no significant increase in the Letter + Order + Incentive arm compared to Letter + Order (absolute difference of -0.4; 95% CI: -9.7 to 8.8; p=0.93).

Conclusions

There was an increase in HCC surveillance from mailed outreach with opt-out framing and a signed order slip, but no increase in response to the financial incentive.

SUBMITTER: Mehta SJ 

PROVIDER: S-EPMC10727671 | biostudies-literature | 2024 Jan

REPOSITORIES: biostudies-literature

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Publications

A randomized trial of mailed outreach with behavioral economic interventions to improve liver cancer surveillance.

Mehta Shivan J SJ   McDonald Caitlin C   Reitz Catherine C   Kastuar Shivani S   Snider Christopher K CK   Okorie Evelyn E   McNelis Kiernan K   Shaikh Hamzah H   Cook Tessa S TS   Goldberg David S DS   Rothstein Kenneth K  

Hepatology communications 20231215 1


<h4>Background</h4>Surveillance rates for HCC remain limited in patients with cirrhosis. We evaluated whether opt-out mailed outreach increased uptake with or without a $20 unconditional incentive.<h4>Methods</h4>This was a pragmatic randomized controlled trial in an urban academic health system including adult patients with cirrhosis or advanced fibrosis, at least 1 visit to a specialty practice in the past 2 years and no surveillance in the last 7 months. Patients were randomized in a 1:2:2 ra  ...[more]

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