Behavioral Economic Approaches to Increase Colorectal Cancer Screening
Ontology highlight
ABSTRACT:
DISEASE(S): Cancer Of The Colon,Colonic Neoplasms
PROVIDER: 2206599 | ecrin-mdr-crc |
REPOSITORIES: ECRIN MDR
Similar Datasets
Project description:This is a 3-year pragmatic, randomized clinical trial among average-risk patients at diverse primary care practices who are overdue for colorectal (CRC) screening. This project aims to evaluate the effect of a centralized program that includes direct outreach to patients and visit-based, clinician directed nudges facilitated by the electronic health record (EHR) with follow-up text messaging on the uptake of CRC screening. The primary outcome is CRC screening completion at 3 years. Patient and clinician factors impacting the experience and effectiveness of the intervention will be explored through surveys and qualitative interviews.
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| 2251540 | ecrin-mdr-crc
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| 2151895 | ecrin-mdr-crc
Project description:Rationale: Lung-protective ventilation (LPV) improves outcomes in patients with acute respiratory distress syndrome (ARDS) and has also shown benefits in patients without ARDS. Despite this evidence, LPV use remains low.Objectives: To understand clinicians' perceptions of using behavioral economic strategies to improve rates of LPV use.Methods: We conducted semistructured interviews of clinicians across seven intensive care units within a university health system. We purposefully sampled clinicians of different professional backgrounds and experience levels. Each interview included descriptions of three of five strategies grounded in behavioral economic theory designed to facilitate clinicians' use of LPV: 1) an order set autopopulated with LPV settings ("default"), 2) an order set providing a choice between autopopulated LPV settings and open-ended order entry for alternative settings ("active choice"), 3) requirement of written justification if settings other than LPV were ordered or documented ("accountable justification"), 4) automated ARDS identification and clinician prompting ("alert"), and 5) provision of clinicians' and their peers' individual rates of LPV use ("peer comparison"). Descriptions were followed by open-ended questions to elicit perceptions about advantages, disadvantages, and acceptability. Initial interview transcripts were reviewed by two investigators to develop a thematic codebook, which was refined iteratively with the use of constant comparative methods.Results: We completed 17 interviews of physicians, nurse practitioners, and respiratory therapists. Strategies that prepopulated settings (default, active choice, and accountable justification) were perceived as providing benefit by reducing workloads and serving as cognitive prompts. The default and active choice strategies were more acceptable than accountable justification, which was perceived as potentially frustrating due to workflow impedance. The alert strategy was met with concerns about alert accuracy and alarm fatigue. The peer comparison strategy led to concerns about timing and fear of punitive measures. Participants believed that the default and active choice strategies would be highly acceptable, whereas few interviewees thought the alert would be acceptable. The active choice strategy was most consistently identified as potentially highly effective.Conclusions: Behavioral economic strategies have great potential as acceptable and potentially effective strategies to increase the use of LPV.
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Project description:People with a psychiatric diagnosis smoke at high rates, yet are rarely treated for tobacco use. Health care systems often use a 'no treatment' default for tobacco, such that providers must actively choose (opt-in) to treat their patients who express interest in quitting. Default bias theory suggests that opt-in systems may reinforce the status quo to not treat tobacco use in psychiatry. We aim to conduct a pilot study testing an opt-out system for implementing a 3A's (ask, advise, assist) tobacco treatment model in outpatient psychiatry. We will use a mixed-methods, cluster-randomized study design. We will implement a tobacco use clinical reminder for outpatient psychiatrists at the VA New York Harbor Healthcare System. Psychiatrists (N = 20) will be randomized 1:1 to one of two groups: (1) Opt-In Treatment Approach: Psychiatrists will receive a reminder that encourages them to offer cessation medications and referral to cessation counseling; or (2) Opt-Out Treatment Approach: Psychiatrists will receive a clinical reminder that includes a standing cessation medication order and a referral to cessation counseling that will automatically generate unless the provider cancels. Prior to implementation of the reminders, we will hold a 1-hour training on tobacco treatment for psychiatrists in both arms. We will use VA administrative data to calculate the study's primary outcomes: 1) the percent of smokers prescribed a cessation medication and 2) the percent of smokers referred to counseling. During the intervention period, we will also conduct post-visit surveys with a cluster sample of 400 patients (20 per psychiatrist) to assess psychiatrist fidelity to the 3 A's approach and patient perceptions of the opt-out system. At six months, we will survey the clustered patient sample again to evaluate the study's secondary outcomes: 1) patient use of cessation treatment in the prior 6 months and 2) self-reported 7-day abstinence at 6 months. At the end of the intervention period, we will conduct semi-structured interviews with 12-14 psychiatrists asking about their perceptions of the opt-out approach. This study will produce important data on the potential of opt-out systems to overcome barriers in implementing tobacco use treatment in outpatient psychiatry. Clinicaltrials.gov Identifier NCT04071795 (registered August 28, 2019). https://www.clinicaltrials.gov/ct2/show/NCT04071795.
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Project description:The cigarette purchase task (CPT) is a behavioral economic method for assessing demand for cigarettes. Growing interest in behavioral correlates of tobacco use in clinical and general populations as well as empirical efforts to inform policy has seen an increase in published articles employing the CPT. Accordingly, an examination of the published methods and procedures for obtaining these behavioral economic metrics is timely. The purpose of this investigation was to provide a review of published approaches to using the CPT. We searched specific Boolean operators (["behavioral economic" AND "purchase task"] OR ["demand" AND "cigarette"]) and identified 49 empirical articles published through the year 2018 that reported administering a CPT. Articles were coded for participant characteristics (e.g., sample size, population type, age), CPT task structure (e.g., price framing, number and sequence of prices; vignettes, contextual factors), and data analytic approach (e.g., method of generating indices of cigarette demand). Results of this review indicate no standard approach to administering the CPT and underscore the need for replicability of these behavioral economic measures for the purpose of guiding clinical and policy decisions. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Project description:Background and study aims
While colorectal cancer (CRC) screening can detect cancer at an early stage, participation in CRC screening programmes is often below recommended levels. In order to be effective, CRC screening programs high participation. There is therefore an interest in studying possible interventions to achieve high participation. While interventions such as pre-notification letters, tailored reminder letters and telephone contact can increase participation, they are often too costly for the screening programmes. Interventions based on behavioural economics only manipulate the decision setting and are therefore potentially cost-neutral. The aim of this study is to test whether messages derived from behavioral economics can increase participation in the context of the Cypriot pilot program for colorectal cancer screening.
Who can participate?
All residents aged 50-69 years who are eligible for colorectal cancer screening.
What does the study involve?
In the first study participants are randomly allocated to receive the standard invitation letter with one of six additional behavioral economics-based messages included, or the standard invitation letter with no manipulation. The additional behavioural economics-based messages are built on the following principles: (1) social responsibility to look after own health, (2) anticipated regret of non-attendance, (3) financial opportunity costs of non-attendance, (4) benefit of early detection, (5) limited duration of the offer and (6) social norms. In the second study participants are randomly allocated to receive either the standard invitation letter with the most effective message from the first study, or the standard invitation letter with no manipulation.
| 2412318 | ecrin-mdr-crc
Project description:The primary objective of this clinical trial will be to compare overall colorectal cancer (CRC) screening participation between an active choice (fecal immunochemical test [FIT] or colonoscopy) and a sequential choice (FIT offered first, then colonoscoscopy offered in those still unscreened) arm. Secondarily, we will (1) compare the proportions of FIT vs. colonoscopy per arm, (2) compare active choice vs FIT only in the initial 3 months of the study, (3) characterize changes in physician knowledge and attitudes regarding CRC screening before and after an educational seminar delivered at the launch of the initiative, (4) characterize perceptions regarding the effect of the intervention on clinical practices, and (5) compare detection rates of CRC, adenomas and SSLs per arm, and the operational results of the outreach program across arms.
| 2381652 | ecrin-mdr-crc
Project description:This is a 4-arm cluster randomized controlled trial to evaluate whether patient financial incentives directly integrated into primary care can improve fecal occult blood test (FOBT) completion rates. We will recruit primary care patients at the Philadelphia Veterans Affairs Medical Center (PVAMC) in 2 stages. In stage 1, we hypothesize that, compared to usual care, $5, $10, $20 incentives will each lead to a statistically significant increase in the rate of FOBT completion. We also hypothesize that there will be a direct dose-response relationship between the incentive amount and rates of FOBT completion. In stage 2, we hypothesize that a lottery-based incentive and a raffle-based incentive will both lead to a statistically significant increase in the rate of FOBT completion compared to a fixed payment incentive with an equivalent dollar per patient value.
| 2119092 | ecrin-mdr-crc