Gupta Samir, Miller Stacie, Koch Mark, Berry Emily, Anderson Paula, Pruitt Sandi L, Borton Eric, Hughes Amy E, Carter Elizabeth, Hernandez Sylvia, Pozos Helen, Halm Ethan A, Gneezy Ayelet, Lieberman Alicea J, Sugg Skinner Celette, Argenbright Keith, Balasubramanian Bijal
San Diego Veterans Affairs Healthcare System, San Diego, California, USA.
Department of Internal Medicine, Division of Gastroenterology, and the Moores Cancer Center, University of California San Diego, San Diego, California, USA.
Am J Gastroenterol. 2016 Nov;111(11):1630-1636. doi: 10.1038/ajg.2016.286. Epub 2016 Aug 2.
Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.
We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.
FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.
Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.
提供经济激励措施以促进或“推动”参与癌症筛查项目，尤其是在传统筛查率较低的弱势群体中，已被提议作为提高筛查接受率的一种策略。然而，此类做法的有效性尚未得到证实。我们的目的是确定提供小额经济激励是否会增加低收入、未参保人群的结直肠癌（CRC）筛查完成率。
我们在得克萨斯州沃思堡市一个大型安全网医疗系统服务的50 - 64岁未进行最新CRC筛查的初级保健患者中进行了一项随机、比较有效性试验。患者被随机分配到邮寄粪便免疫化学检测（FIT）外展组（n = 6565）、外展加5美元激励组（n = 1000）或外展加10美元激励组（n = 1000）。外展包括提醒电话以及为FIT异常的患者提供促进诊断性结肠镜检查完成的引导。主要结局是1年内FIT完成情况，采用意向性筛查分析进行评估。
有经济激励时FIT完成率为36.9%，无任何经济激励时为36.2%（P = 0.60），10美元激励组（34.6%，与无激励组相比P = 0.32）或5美元激励组（39.2%，与无激励组相比P = 0.07）的完成率在统计学上也无差异。按年龄、性别、种族/族裔或邻里贫困率分层时结果也无实质性差异。各组FIT返回的中位时间也无差异。
为回应邮寄的完成FIT邀请而提供的5美元或10美元经济激励不会影响CRC筛查的完成率。
