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Financial Incentives to Increase Colorectal Cancer Screening in Priority Populations

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ClinicalTrials.gov Identifier: NCT03080701
Recruitment Status : Completed
First Posted : March 15, 2017
Last Update Posted : November 5, 2019
Sponsor:
Collaborators:
University of Michigan
University of Texas
Information provided by (Responsible Party):
Kaiser Permanente

Brief Summary:
The investigators propose to build on the success of the Systems of Support to Increase Colorectal Cancer trial (SOS, R01CA121125, Green) and focus on disparity groups who are less likely to be current for colorectal cancer (CRC) screening. We will test whether financial incentives increases screening uptake and decreases screening disparities. The investigators hypothesize that CRC screening rates will be higher in patients offered mailed fecal kits and financial incentives than those offered mailed fecal kits alone.

Condition or disease Intervention/treatment Phase
Colorectal Cancer Behavioral: Auto Mailing Plus Money Behavioral: Auto Mailing Plus Lottery Not Applicable

Detailed Description:
Study staff will send invitation letters and a questionnaire to 5,000 patients aged 50-75 not current for CRC screening, two-thirds who are identified in the electronic data as being from a non-White race, ethnicity, or who have Medicaid coverage. Those returning the survey and remaining eligible (estimated N = 1150) will be randomized to either (1) Mailed fecal kit only, or mailed fecal kit plus one of 2 types of financial incentives for completing testing: (2) a guaranteed Monetary incentive or (3) a probabilistic Lottery incentive.

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Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 898 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Masking Description: The randomization sequence will be concealed to everyone except the study biostatistician.
Primary Purpose: Screening
Official Title: Systems of Support (SOS) to Increase Colon Cancer Screening Disparities Supplement
Actual Study Start Date : March 23, 2017
Actual Primary Completion Date : November 2, 2018
Actual Study Completion Date : November 2, 2018

Resource links provided by the National Library of Medicine


Arm Intervention/treatment
No Intervention: Group 1 - Automated Mailing
The mailing process will be identical to those used in the SOS study. Mailing 1 includes an introductory letter on CRC screening and a pamphlet on CRC testing choices (colonoscopy every 10 years, FIT testing yearly, or flexible sigmoidoscopy every 10 years combined with interval FIT testing), and pros and cons of each. The letter will state that they will soon be receiving a FIT kit in the mail, and a number to call if they prefer another option. Mailing 2 includes a brief letter reaffirming the importance of screening, a FIT kit (the one used by Group Health), pictograph instructions, and a postage-paid return envelope. Mailing 3 a reminder letter, is sent to participants not completing the FIT kit after 3 weeks. The intervention for Group 1 includes no incentive.
Experimental: Group 2 - Auto Mailing Plus Money
Receives the same number of mailings and materials as group 1 with the following modifications. In Mailing 1 the letter will include the intervention notification that they will receive a monetary thank you gift for completing testing (FIT colonoscopy or flex sig within 6 months). Mailing 2 and mailing 3 (reminder letters for those still not returning kits) will include the same information about the monetary thank you gift for CRC screening completion. Mailing 4 will include the money with a thank you letter for those who complete the screening
Behavioral: Auto Mailing Plus Money
Participant receives money as a thank you for completing CRC screening within 6 months.

Experimental: Group 3 - Auto Mailing Plus Lottery
Receives the same number of mailings and materials as group 1 with the following modifications. In Mailing 1 the letter will include the intervention notification that they will have a 1 in 10 chance of winning money (FIT, colonoscopy or flex sig within 6 months). Mailing 2 and mailing 3 (reminder letters for those still not returning kits) will include the same information about the 1 in 10 chance of winning the lottery for CRC screening completion. Mailing 4 will include a thank you letter with money for those who complete their screening and win the lottery. Participants who do not win the lottery will receive a thank you letter.
Behavioral: Auto Mailing Plus Lottery
Participant has a 1 in 10 chance of winning money in a lottery for completing CRC screening within 6 months.




Primary Outcome Measures :
  1. CRC Screening Within 6 Months Following Randomization [ Time Frame: 6 months ]
    We will compare among the 3 arms (1) automated mailing; (2) Auto mailing plus $10; (3) Auto mailing plus $50 lottery for completion and the effect of each on CRC screening completion at 6 months (yes/no) within the following subgroups of each arm: 1. White and not Hispanic versus non-White or Hispanic. 2. Medicaid versus non-Medicaid (Medicare, employer-based, private) insurance. 3. History of prior versus no prior completion of CRC screening tests. 4. High school or less versus college or more education level.



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Ages Eligible for Study:   50 Years to 75 Years   (Adult, Older Adult)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • No evidence in electronic data of FIT screening in past year or a colonoscopy in the prior 9 years.
  • Continuously enrolled in Group Health Cooperative (GHC) for at least one year.
  • Patients who have Medicaid coverage or are non-white race or Hispanic any race.

Exclusion Criteria:

  • Known high risk for CRC
  • History of CRC
  • History of inflammatory bowel disease
  • Current anticoagulation therapy
  • Organ failure
  • Serious illness
  • Debilitating disease
  • Dementia
  • Nursing home resident

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03080701


Locations
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United States, Washington
Group Health Research Institute
Seattle, Washington, United States, 98101
Sponsors and Collaborators
Kaiser Permanente
University of Michigan
University of Texas
Investigators
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Principal Investigator: Beverly B Green, MD, MPH Kaiser Permanente

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Responsible Party: Kaiser Permanente
ClinicalTrials.gov Identifier: NCT03080701     History of Changes
Other Study ID Numbers: 4RO1CA121125-09 REVISED
First Posted: March 15, 2017    Key Record Dates
Last Update Posted: November 5, 2019
Last Verified: November 2019
Individual Participant Data (IPD) Sharing Statement:
Plan to Share IPD: No

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Studies a U.S. FDA-regulated Drug Product: No
Studies a U.S. FDA-regulated Device Product: No
Keywords provided by Kaiser Permanente:
Behavioral: Automated Mailing
Additional relevant MeSH terms:
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Colorectal Neoplasms
Intestinal Neoplasms
Gastrointestinal Neoplasms
Digestive System Neoplasms
Neoplasms by Site
Neoplasms
Digestive System Diseases
Gastrointestinal Diseases
Colonic Diseases
Intestinal Diseases
Rectal Diseases