INTRODUCTION Colorectal cancer (CRC) is a major cause of cancer-related morbidity and mortality in the United States. Although various interventions have improved screening rates, they often require abundant resources and can be difficult to implement. Social psychology and behavioral economics principles offer an opportunity for low-cost and easy-to-implement strategies but are less common in clinical settings. METHODS We randomized 2,000 patients aged 50-75 years eligible for CRC screening to one of the 2 mailed interventions: a previously used text-based letter describing and offering fecal immunochemical testing (FIT) and colonoscopy (usual care arm); or a letter leveraging social psychology and behavioral economics principles (e.g., implied scarcity and choice architecture), minimal text, and multiple images to offer FIT and colonoscopy (intervention arm). We compared total screening uptake, FIT uptake, and colonoscopy uptake at 1-month intervals in each group. RESULTS There were 1,882 patients included in the final analysis. The mean age was 69.3 years, and baseline characteristics in the 2 groups were similar. Screening completion at 26 weeks was 19.5% in the usual care arm (16.3% FIT vs 3.2% colonoscopy, P < 0.01) and 24.1% in the intervention arm (22.1% FIT vs 2.0% colonoscopy, P < 0.01) (P = 0.02). DISCUSSION Among primary care patients aged 50-75 years in an academic setting, mailed CRC outreach employing social psychology and behavioral economics principles led to a higher participation in CRC screening than usual care mailed outreach. TRANSLATIONAL IMPACT Mailed interventions to increase CRC screening should incorporate social psychology and behavioral economics principles to improve participation.

中文翻译：

---

行为经济学原理的应用提高了参与大肠癌筛查的邮件推广的参与度。

简介结直肠癌（CRC）是美国癌症相关发病率和死亡率的主要原因。尽管各种干预措施提高了筛查率，但它们往往需要大量资源，并且可能难以实施。社会心理学和行为经济学原理为低成本和易于实施的策略提供了机会，但在临床环境中并不常见。方法我们将2,000名年龄在50-75岁之间，可进行CRC筛查的患者随机分配至以下两种邮寄干预措施之一：以前使用的基于文字的信函，描述并提供了粪便免疫化学检测（FIT）和结肠镜检查（常规护理）；或利用社会心理学和行为经济学原理（例如，隐含的稀缺性和选择架构）的信函，最少的文字，以及提供FIT和结肠镜检查（干预臂）的多个图像。我们比较了每组中每1个月间隔的总筛查摄入量，FIT摄入量和结肠镜检查的摄入量。结果最终分析包括1,882例患者。平均年龄为69.3岁，两组的基线特征相似。在常规治疗组中，第26周的筛查完成率为19.5％（FIT分别为16.3％vs 3.2％结肠镜检查，P <0.01）和干预组为24.1％（22.1％FIT相对于2.0％结肠镜检查，P <0.01）（P = 0.02） ）。讨论在学术环境中，年龄在50-75岁的基层医疗患者中，采用社会心理学和行为经济学原理的CRC邮件外联活动比常规护理邮件外联活动对CRC筛查的参与度更高。