Trial Summary
What is the purpose of this trial?This is a 3-year pragmatic, randomized clinical trial among average-risk patients at diverse primary care practices who are overdue for colorectal (CRC) screening. This project aims to evaluate the effect of a centralized program that includes direct outreach to patients and visit-based, clinician directed nudges facilitated by the electronic health record (EHR) with follow-up text messaging on the uptake of CRC screening. The primary outcome is CRC screening completion at 3 years. Patient and clinician factors impacting the experience and effectiveness of the intervention will be explored through surveys and qualitative interviews.
Eligibility Criteria
This trial is for patients aged 50-72 who are overdue for colorectal cancer screening, have seen a participating primary care physician in the last two years, and aren't up to date with their screenings. It's not for those on hospice or palliative care, uninsured/self-pay individuals, scheduled for colon procedures, at high risk of dying within three years, or with certain gastrointestinal conditions.Inclusion Criteria
Followed by Primary Care with a participating Penn Medicine PCP listed and at least one visit in the last 2 years
I am between 50 and 72 years old.
I am not current with my colorectal cancer screenings.
Exclusion Criteria
Uninsured or self-pay patients
I have had my entire colon removed, have dementia, or cancer that has spread.
Elevated chance of mortality within 3 years according to mortality risk algorithm
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Participant Groups
The study tests if direct patient outreach programs and clinician nudges via electronic health records plus follow-up texts increase colorectal cancer screening rates over three years. Patients will be randomly assigned to receive different types of reminders or no reminder about CRC screening.
5Treatment groups
Experimental Treatment
Group I: Arm 3B: Sequential Choice and Visit-Based Nudge/TextExperimental Treatment2 Interventions
Using bulk ordering, patients assigned to this arm will receive an order for colonoscopy and direct outreach (via text message and either the electronic patient portal or mailed letter, depending on their patient portal status) informing them they are overdue for CRC screening. If not completed, patients will receive an order and a mailed fecal immunochemical test (FIT) with a reminder to complete CRC screening. Patients randomized to this arm who attend a visit with their Primary Care Physician (PCP) will additionally receive a visit-based, clinician directed nudge to discuss colorectal cancer screening and a follow-up text 3 days post-visit to encourage screening completion.
Group II: Arm 3A: Sequential Choice and No Nudge/TextExperimental Treatment2 Interventions
Using bulk ordering, patients assigned to this arm will receive an order for colonoscopy and direct outreach (via text message and either the electronic patient portal or mailed letter, depending on their patient portal status) informing them they are overdue for CRC screening. If not completed, patients will receive an order and a mailed fecal immunochemical test (FIT) with a reminder to complete CRC screening. Patients randomized to this arm will not receive visit-based interventions.
Group III: Arm 2B: Colonoscopy Only and Visit-Based Nudge/TextExperimental Treatment2 Interventions
Using bulk ordering, patients assigned to this arm will receive an order for colonoscopy and direct outreach (via text message and either the electronic patient portal or mailed letter, depending on their patient portal status) informing them they are overdue for CRC screening. Patients randomized to this arm who attend a visit with their Primary Care Physician (PCP) will additionally receive a visit-based, clinician directed nudge to discuss colorectal cancer screening and a follow-up text 3 days post-visit to encourage screening completion.
Group IV: Arm 2A: Colonoscopy Only and No Nudge/TextExperimental Treatment2 Interventions
Using bulk ordering, patients assigned to this arm will receive an order for colonoscopy and direct outreach (via text message and either the electronic patient portal or mailed letter, depending on their patient portal status) informing them they are overdue for CRC screening. Patients randomized to this arm will not receive visit-based interventions.
Group V: Arm 1A: Usual CareExperimental Treatment2 Interventions
Patients assigned to the Usual Care arm will receive current usual care and will not receive direct patient outreach or any visit-based interventions from this trial.
Find a Clinic Near You
Research Locations NearbySelect from list below to view details:
Penn MedicinePhiladelphia, PA
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Who Is Running the Clinical Trial?
Abramson Cancer Center at Penn MedicineLead Sponsor
Abramson Cancer Center of the University of PennsylvaniaLead Sponsor