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Testing behavioral economics principles in mailed FIT outreach: a randomized trial.
Oyinkansola Adedipe1, Nina Bartmann2, Lawrence Greenblatt1
1Division of General Internal Medicine, Duke University School of Medicine, Durham, NC, USA.
Cancer Causes & Control : CCC
|July 2, 2026
Summary
Enhancing mailed colorectal cancer (CRC) screening kits with behavioral economics principles did not significantly increase fecal immunochemical test (FIT) completion rates. Mailed FIT remains a cost-effective tool for reaching individuals for CRC screening.
Area of Science:
- Public Health
- Preventive Medicine
- Behavioral Science
Background:
- Mailed fecal immunochemical testing (FIT) is effective in increasing colorectal cancer (CRC) screening rates.
- Behavioral economics principles can influence health-related behaviors.
- Optimizing communication strategies for mailed FIT is crucial for improving screening adherence.
Purpose of the Study:
- To evaluate if enhanced communication, using behavioral economics principles, improves CRC screening rates via mailed FIT kits.
- To compare the completion rates of FIT tests between standard and enhanced communication groups.
- To identify factors associated with FIT test completion in a Medicare population.
Main Methods:
- A randomized controlled trial involving Medicare patients at average risk for CRC.
- Intervention groups received either standard communication or enhanced communication incorporating behavioral economics principles.
- Completion of FIT tests within 90 days was the primary outcome measure.
Main Results:
- Overall FIT completion rate was 27% within 90 days.
- Enhanced communication showed a slightly higher completion rate (28.1%) compared to standard communication (25.5%), but the difference was not statistically significant (p=0.094).
- Younger age and greater area-level deprivation were associated with lower FIT completion rates.
Conclusions:
- Enhanced communication using behavioral economics principles did not significantly improve mailed FIT completion rates for CRC screening.
- Mailed FIT remains a valuable and cost-effective method for CRC screening, particularly for reaching unscreened populations.
- Further research may explore alternative or combined strategies to enhance screening adherence.
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