Beverly B. Green|Melissa L. Anderson|Andrea J. Cook|Jessica Chubak|Sharon Fuller|Kilian Kimbel|Jeffrey T. Kullgren|Richard T. Meenan|Sally W. Vernon
Financial Incentives to Increase Colorectal Cancer Screening Uptake and Decrease Disparities
Kaiser Permanente|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Washington Health Research Institute|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Washington Health Research Institute|University of Washington|Kaiser Permanente Washington Health Research Institute|Kaiser Permanente Washington Health Research Institute|VA Ann Arbor Healthcare System|University of Michigan–Ann Arbor|Kaiser Permanente Center for Health Research|The University of Texas Health Science Center at Houston
colorectal cancer screening rates suboptimal particularly among sociodemographically disadvantaged groupsto examine whether guaranteed money probabilistic lottery financial incentives conditional completion colorectal cancer screening increase screening uptake particularly among groups lower screening ratesthis parallel 3arm randomized clinical trial conducted march 13 2017 april 12 2018 21 medical centers integrated health care system western washington total 838 ageeligible patients overdue colorectal cancer screening completed questionnaire confirmed eligibility included sociodemographic psychosocial questions enrolledinterventions 1 mail n 284 3 mailings included information importance colorectal cancer screening screening test choices fecal immunochemical test fit reminder letter necessary 2 mail monetary n 270 mailings plus guaranteed 10 screening completion 3 mail lottery n 284 mailings plus 1 10 chance receiving 50 screening completionthe primary outcome completion colorectal cancer screening within 6 months randomization secondary outcomes fit colonoscopy completion within 6 months randomization intervention effects compared across sociodemographic subgroups selfreported psychosocial measuresa total 838 participants mean sd age 597 72 years 546 652 female 433 522 white race 101 121 hispanic ethnicity included study completion colorectal screening significantly higher mail monetary group 207 270 767 mail lottery group 212 284 746 mail group 203 284 715 p 11 fit completion interventions statistically significant effect p 04 net increase 77 95 ci 03151 mail monetary group 71 95 ci 02 143 mail lottery group compared mail group patients medicaid insurance net increase compared mail fit completion mail monetary mail lottery group 377 95 ci 110643 342 mail monetary group 404 mail lottery group compared net increase 56 95 ci 09 122 among medicaid insured test interaction p 03financial incentives increased fit uptake overall colorectal cancer screening financial incentives may decrease screening disparities among sociodemographically disadvantaged groupsclinicaltrialsgov identifier nct00697047