Background & Aims

Financial incentives might increase participation in prevention such as screening colonoscopy. We studied whether incentives informed by behavioral economics increase participation in risk assessment for colorectal cancer (CRC) and completion of colonoscopy for eligible adults.

Methods

Employees of a large academic health system (50–64 y old; n = 1977) were randomly assigned to groups that underwent risk assessment for CRC screening and direct access colonoscopy scheduling (control), or risk assessment, direct access colonoscopy scheduling, a $10 loss-framed incentive to complete risk assessment, and a $25 unconditional incentive for colonoscopy completion (incentive). The primary outcome was the percentage of participants who completed screening colonoscopy within 3 months of initial outreach. Secondary outcomes included the percentage of participants who scheduled colonoscopy and the percentage who completed the risk assessment.

Results

At 3 months, risk assessment was completed by 19.5% of participants in the control group (95% CI, 17.0–21.9%) and 31.9% of participants in the incentive group (95% CI, 29.0–34.8%) (P < .001). At 3 months, 0.7% of controls had completed a colonoscopy (95% CI, .2%–1.2%) compared with 1.2% of subjects in the incentive group (95% CI, .5%–1.9%) (P = .25).

Conclusions

In a randomized trial of participants who underwent risk assessment for CRC with vs without financial incentive, the financial incentive increased CRC risk assessment completion but did not result in a greater completion of screening colonoscopy. Clinicaltrials.gov no: NCT03068052.

中文翻译：

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随机试验中行为经济激励对结直肠癌筛查的影响

背景与目标

经济激励可能会增加对预防的参与，例如结肠镜检查。我们研究了基于行为经济学的激励措施是否增加了对结直肠癌 (CRC) 风险评估和符合条件的成年人完成结肠镜检查的参与。

方法

大型学术卫生系统的员工（50-64 岁；n = 1977）被随机分配到接受 CRC 筛查和直接访问结肠镜检查计划（对照）风险评估的组，或风险评估、直接访问结肠镜检查计划组，10 美元完成风险评估的损失框架激励，以及完成结肠镜检查的 25 美元无条件激励（激励）。主要结果是在初次外展后 3 个月内完成结肠镜检查的参与者百分比。次要结果包括安排结肠镜检查的参与者百分比和完成风险评估的百分比。

结果

在 3 个月时，对照组 19.5% 的参与者（95% CI，17.0-21.9%）和激励组 31.9% 的参与者（95% CI，29.0-34.8%）完成了风险评估（P < . 001)。在 3 个月时，0.7% 的对照组完成了结肠镜检查（95% CI，0.2%–1.2%），而激励组为 1.2%（95% CI，0.5%–1.9%）（P = . 25)。

结论

在一项对接受 CRC 风险评估的参与者进行的随机试验中，有与没有经济激励相比，经济激励增加了 CRC 风险评估的完成，但并未导致更大程度地完成结肠镜检查。Clinicaltrials.gov 编号：NCT03068052。