EHR-Nudges for Breast Cancer Screening
(I-SCREEN Trial)

Recruiting in Palo Alto (17 mi)

+1 other location

Overseen byAmol Navathe, MD, PhD

Age: 18+

Sex: Female

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Abramson Cancer Center at Penn Medicine

No Placebo Group

Trial Summary

What is the purpose of this trial?In this study, personalized nudges to clinicians and patients will be evaluated to help increase breast cancer screening rates in accordance with USPSTF guidelines among women with a primary care visit, with a particular emphasis on those at high risk for non-completion of cancer screening. In partnership with Penn Medicine (Penn) and Case Western Reserve University-University Hospitals (UH), two complementary, concurrent, 6-month, cluster-randomized, pragmatic trials will be conducted. Those assigned to the intervention arm will receive the following clinician and patient level nudge interventions: clinicians will receive a default pended order for a mammogram in the visit encounter in the EHR (Penn and UH), and patients will receive post-visit text message reminders to encourage them to schedule their mammogram (Penn). Patients identified as high risk for noncompletion will be individually randomized to receive an additional bidirectional text message nudge or the standard text messaging (Penn).

Eligibility Criteria

This trial is for women aged 40-74 who are overdue for a mammogram, have an upcoming primary care visit but no future mammogram scheduled. High-risk patients include those with Medicare or Medicaid, or limited use of the EHR patient portal. Women with bilateral mastectomy or without a phone number listed in their chart cannot participate.

Inclusion Criteria

A scheduled new or return (non-urgent/sick) primary care visit at one of the study practices (Penn Trial) or with one of the study primary care providers (UH Trial)

Are overdue and eligible for a mammogram per Health Maintenance

Does not have a future scheduled mammogram appointment

+2 more

Exclusion Criteria

Have a mammogram exclusion modifier in Health Maintenance

I have had both of my breasts removed.

Have no phone number (home or mobile) listed in their chart (Penn Trial only)

Participant Groups

The study tests if electronic health record (EHR) prompts and text message reminders can increase breast cancer screening rates. Clinicians get default orders to recommend mammograms, while patients receive texts reminding them to schedule one. High-risk individuals may also get extra bidirectional messaging.

5Treatment groups

Experimental Treatment

Active Control

Group I: UH: InterventionExperimental Treatment1 Intervention

Primary care providers randomized to the intervention arm will receive default pended orders for a mammogram.

Group II: Penn: InterventionExperimental Treatment2 Interventions

Clinics randomized to the intervention arm will receive the toolkit of clinician and patient facing nudges. Patient nudges will be post-visit text message reminders (standard messaging content). Clinician nudges will be default pended orders.

Group III: Penn: High Risk IntensificationExperimental Treatment3 Interventions

Patients in the intervention clinics identified as high risk for noncompletion of mammogram will be randomized 1:1 to receive the high risk intensification arm or remain in the standard intervention arm. Patients in the high risk intensification arm will receive an additional bidirectional texting component.

Group IV: UH: ControlActive Control1 Intervention

Primary care providers randomized to the control arm will receive standard of care.

Group V: Penn: ControlActive Control1 Intervention

Clinics randomized to the control arm will receive standard of care.