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Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial

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  • Peter H. Schwartz
  • Susan M. Perkins
  • Karen K. Schmidt
  • Paul F. Muriello
  • Sandra Althouse
  • Susan M. Rawl

Abstract

Background. Guidelines recommend that patient decision aids should provide quantitative information about probabilities of potential outcomes, but the impact of this information is unknown. Behavioral economics suggests that patients confused by quantitative information could benefit from a “nudge†towards one option. We conducted a pilot randomized trial to estimate the effect sizes of presenting quantitative information and a nudge. Methods. Primary care patients (n = 213) eligible for colorectal cancer screening viewed basic screening information and were randomized to view (a) quantitative information (quantitative module), (b) a nudge towards stool testing with the fecal immunochemical test (FIT) (nudge module), (c) neither a nor b, or (d) both a and b. Outcome measures were perceived colorectal cancer risk, screening intent, preferred test, and decision conflict, measured before and after viewing the decision aid, and screening behavior at 6 months. Results. Patients viewing the quantitative module were more likely to be screened than those who did not ( P = 0.012). Patients viewing the nudge module had a greater increase in perceived colorectal cancer risk than those who did not ( P = 0.041). Those viewing the quantitative module had a smaller increase in perceived risk than those who did not ( P = 0.046), and the effect was moderated by numeracy. Among patients with high numeracy who did not view the nudge module, those who viewed the quantitative module had a greater increase in intent to undergo FIT ( P = 0.028) than did those who did not. Limitations. The limitations of this study were the limited sample size and single healthcare system. Conclusions. Adding quantitative information to a decision aid increased uptake of colorectal cancer screening, while adding a nudge to undergo FIT did not increase uptake. Further research on quantitative information in decision aids is warranted.

Suggested Citation

  • Peter H. Schwartz & Susan M. Perkins & Karen K. Schmidt & Paul F. Muriello & Sandra Althouse & Susan M. Rawl, 2017. "Providing Quantitative Information and a Nudge to Undergo Stool Testing in a Colorectal Cancer Screening Decision Aid: A Randomized Clinical Trial," Medical Decision Making, , vol. 37(6), pages 688-702, August.
    • Handle: RePEc:sae:medema:v:37:y:2017:i:6:p:688-702
    DOI: 10.1177/0272989X17698678
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    References listed on IDEAS

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    1. Célia Berchi & Maximilien Nayaradou & Olivier Dejardin & Guy Launoy, 2010. "Eliciting population preferences for mass colorectal cancer screening organization," Post-Print halshs-00478487, HAL.
    2. Eric Johnson & Suzanne Shu & Benedict Dellaert & Craig Fox & Daniel Goldstein & Gerald Häubl & Richard Larrick & John Payne & Ellen Peters & David Schkade & Brian Wansink & Elke Weber, 2012. "Beyond nudges: Tools of a choice architecture," Marketing Letters, Springer, vol. 23(2), pages 487-504, June.
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    1. Bahman Ahadinezhad & Aisa Maleki & Amirali Akhondi & Mohammadjavad Kazemi & Sama Yousefy & Fatemeh Rezaei & Omid Khosravizadeh, 2024. "Are behavioral economics interventions effective in increasing colorectal cancer screening uptake: A systematic review of evidence and meta-analysis?," PLOS ONE, Public Library of Science, vol. 19(2), pages 1-17, February.
    2. Mizota, Yuri & Yamamoto, Seiichiro, 2021. "Rainbow of KIBOU project: Effectiveness of invitation materials for improving cancer screening rate using social marketing and behavioral economics approaches," Social Science & Medicine, Elsevier, vol. 279(C).
    3. Carissa Bonner & Lyndal J. Trevena & Wolfgang Gaissmaier & Paul K. J. Han & Yasmina Okan & Elissa Ozanne & Ellen Peters & Daniëlle Timmermans & Brian J. Zikmund-Fisher, 2021. "Current Best Practice for Presenting Probabilities in Patient Decision Aids: Fundamental Principles," Medical Decision Making, , vol. 41(7), pages 821-833, October.

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