More options do not increase colorectal cancer screening

SAN DIEGO — Presenting individuals with more choices did not increase the likelihood of participation in colorectal cancer screening programs, according to study results presented at Digestive Disease Week.

Shivan J. Mehta, MD, MBA, MSPH, of the Perelman School of Medicine at the University of Pennsylvania, said with so many screening options available, it can be hard to know which direction to go in.

“There’s not a consensus from the different guidelines about how to offer choice, and specifically how to conduct outreach related to the different screening options,” he said in his presentation. “We tried to evaluate whether the framing of choice between FIT and colonoscopy could impact the choice between those two modalities.”

Researchers conducted a three-arm pragmatic, randomized controlled trial to evaluate different strategies for mailed CRC screening outreach. They randomly assigned patients aged 50 to 74 years (n = 438) into three groups. The first received a direct phone number to call to schedule a colonoscopy (n = 146). The second also received that number but also received a mailed FIT kit if they did not respond within 4 weeks (sequential choice, n = 146). The third received the colonoscopy scheduling number as well as a FIT kit at initial outreach (active choice, n = 146).

Mehta and colleagues found that just 5.5% of patients in the colonoscopy only group completed screening within 4 months compared with 12.3% in the sequential choice group and 12.3% in the active choice group (both P = .04).

Although there was no difference in overall CRC among the sequential and active choice groups, five patients in the sequential choice arm (3.4%) underwent colonoscopy compared with none in the active choice group.

Mehta said that giving patients more choices might not increase participation in CRC screening.

“Choice architecture and defaults can potentially nudge people to choosing one option over another option just in terms of how you offer the default,” he said. “We know that patients will often go with the status quo, because we’re all subject to status quo bias.” – by Alex Young

Reference:

Mehta S, et al. Abstract 842. Presented at: Digestive Disease Week; May 18-21, 2019; San Diego.

Disclosures: Mehta reports no relevant financial disclosures. Please see the meeting disclosure index for all other authors’ relevant financial disclosures.