Department of Research and Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Ave, Pasadena, CA, 91101, USA.
Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, Pasadena, CA, USA.
J Gen Intern Med. 2021 Apr;36(4):952-960. doi: 10.1007/s11606-020-06392-y. Epub 2021 Jan 20.
Despite significant investment in colorectal cancer (CRC) screening, 40% of US adults are not up-to-date. Commitment devices, which are psychologically tailored approaches to enforce health goals, may be an effective method to increase CRC screening.
Compare the effectiveness of a commitment device (patient self-ordering fecal immunochemical test (FIT) kits) to standard CRC screening outreach.
A retrospective observational study.
Participants were > 49 years and < 75 years, had no history of CRC, and were eligible for CRC screening.
An electronic screening reminder with an embedded order button allowed participants to order FIT kits directly from a patient portal. Those who used the order button were promptly sent a kit; those who did not were later mailed kits.
Primary outcome was completion of FIT kits. Secondary outcomes included number of days to completion, completion of follow-up for positive results, and CRC diagnosis; we also examined prior use of FIT kit. We used inverse probability of treatment weights to control for pretreatment imbalances.
The cohort comprised 176,231 participants: 53% female; median age was 59; 11% were Asian, 21% Hispanic/Latino, 7% black, 51% White, 3% other/mixed race. Approximately 10% (N = 16,918) used the button. Using inverse probability of treatment weights, we found that those who used the button had 3.8 times the odds of completing a kit compared to participants who did not (odds ratio, 3.77; 95% confidence interval, 3.57-3.98). Within the button group, 63% of those eligible completed a FIT kit in the year prior to the button compared to 87% in the year after the button became available (p < 0.0001).
The ability to self-order screening kits may act as a commitment device that increases CRC screening. Scalable tools leveraging existing patient portals such as this can complement existing CRC outreach strategies.
尽管在结直肠癌（CRC）筛查方面投入了大量资金，但仍有 40%的美国成年人未接受最新筛查。承诺装置是一种针对健康目标的心理定制方法，可能是增加 CRC 筛查的有效方法。
比较承诺装置（患者自行订购粪便免疫化学测试（FIT）试剂盒）与标准 CRC 筛查外展的效果。
回顾性观察性研究。
参与者年龄>49 岁且<75 岁，无 CRC 病史，符合 CRC 筛查条件。
电子筛查提醒中嵌入了订购按钮，允许参与者直接从患者门户订购 FIT 试剂盒。使用订购按钮的人会立即收到试剂盒；未使用订购按钮的人随后会邮寄试剂盒。
主要结局是 FIT 试剂盒的完成情况。次要结局包括完成 FIT 试剂盒的天数、阳性结果的随访完成情况以及 CRC 诊断；我们还检查了 FIT 试剂盒的先前使用情况。我们使用逆概率处理权重来控制治疗前的不平衡。
队列包括 176231 名参与者：53%为女性；中位年龄为 59 岁；11%为亚裔，21%为西班牙裔/拉丁裔，7%为黑人，51%为白人，3%为其他/混合种族。约 10%（N=16918）使用了按钮。使用逆概率处理权重，我们发现与未使用按钮的参与者相比，使用按钮的参与者完成试剂盒的几率高 3.8 倍（优势比，3.77；95%置信区间，3.57-3.98）。在按钮组中，在按钮可用前的一年中，有 63%符合条件的人完成了 FIT 试剂盒，而在按钮可用后的一年中，有 87%的人完成了 FIT 试剂盒（p<0.0001）。
自行订购筛查试剂盒的能力可能成为增加 CRC 筛查的承诺装置。这种可扩展的工具可以利用现有的患者门户，补充现有的 CRC 外展策略。
