Patients will receive a reminder letter signed by their family physician which indicates which cancer screening tests they are overdue for and encourages them to book an appointment for screening.

Patients will receive a phone call from a member of the practice staff. The call will inform them about which cancer screening tests they are overdue for and will encourage them to book an appointment for screening.

Letter

Phone call

Aisha Lofters, MD PhD CCFP

Tara Kiran, MD MSc CCFP

This randomized trial aims to understand how effective a reminder letter is compared to a reminder phone call in improving breast, cervical and colorectal cancer screening rates and reducing screening disparities.

Comparing Methods of Recall for Cancer Screening in Primary Care: a Pragmatic Clinical Trial

Comparing Methods of Recall for Cancer Screening in Primary Care: a Pragmatic Randomized Clinical Trial

Unity Health Toronto

Neoplasms

Respiratory Tract (Lung and Bronchial) Diseases

All Conditions

Lung Neoplasms

Respiratory Tract Neoplasms

Thoracic Neoplasms

Lung Diseases

Respiratory Tract Diseases

Patients will receive a letter reminding them that they are overdue for repeat annual screening.

Patients will receive a phone call from community health worker, offering to help them overcome barriers to repeat annual screening and offering to help them schedule their screening.

MaineGeneral Radiology will generate a reminder letter about their need for an annual low dose CT scan to the subjects in this arm.

Community Health Worker Phone Call

This research study will test whether support from a Community Health Worker (CHW) to address barriers to annual LDCT screening will result in an increased number of patients who receive the annual screening as per the recommended standard of care compared to passive outreach using a reminder letter.

This research study is a randomized controlled trial comparing phone outreach by a trained Community Health Worker (CHW) following a reminder letter to the reminder letter alone for patients who are at least a month overdue to have a routine annual low dose CT scan (LDCT) screening for lung cancer. CHWs will be able to identify and address barriers to accessing screening for those patients randomized to that arm of the study. Outcomes that will be measured include scheduling and completing the LDCT as well as agreeing to a referral for tobacco treatment.

Eligible patients will be randomly assigned to one of the following two groups:

1. Control Group:

o Annual reminder letter only

1. Intervention Group:
2. Annual reminder letter and Community Health Worker proactive outreach

Outcomes assessor will be blind to which intervention the subjects have received.

Maine Lung Cancer Coalition: Using CHWs for the Annual Lung Cancer Screening Reminder

Percentage of patients who receive low dose CT scan within 3 months of the date on which they were initially contacted by letter

Percentage of patients who schedule a low dose CT scan within 3 months of the date on which they were initially contacted by letter

Percentage of current smokers in the CHW phone call arm who receive counseling about tobacco treatment

Percentage of current smokers in the CHW phone call arm who accept referral to Maine Tobacco Helpline

Anne Conners

Principal Investigator

Digestive System Diseases

Colorectal Neoplasms

Intestinal Neoplasms

Gastrointestinal Neoplasms

Digestive System Neoplasms

Gastrointestinal Diseases

Colonic Diseases

Intestinal Diseases

Rectal Diseases

The standard letter describes the importance of getting screened and instructs recipients how to use the FIT kit for screening at home.

The standard letter is enhanced with language that further emphasizes the risks but also clearly describes how early detection with a test can reduce those risks; it also explains why test kits are being sent to disarm skepticism about the program.

In addition to the enhancements added by the letter with risks, the letter also includes a table comparing FIT kit and colonoscopy. Presenting different screening options allows recipients to make the choice that best suits them. In addition, presenting multiple options increases the chance that recipients get screened in one way or another.

In addition to the enhancements added by the letter with risk, the comparison table includes comparisons of the consequences of getting screened vs. waiting for symptoms to appear.

Recipients receive a letter promoting CRC screening.

The letter is enhanced with language that frames the situation in terms of losses. It also uses fear appeals by showing the risks of colorectal cancer, while also showing that screening is an achievable means to address those risks.

Loss Frame and Fear Appeals

The letter explains why the kit was sent, which makes the purposes of the mailing clear to the recipient.

Transparency

The pros and cons for screening with FIT kits and colonoscopy are presented. By showing an additional option, the table frames the FIT kit as the default option (since they are included in the mailer). In this situation, inaction is no longer the default option. Changing the default option increases the chance that the FIT kit is used. In addition, another viable alternative is provided (colonoscopy), which still contributes to the goal of the project (getting screened).

Default Effect and Presentation of Alternatives

Comparisons of the mortality rates between screening with FIT kits, colonoscopy, and inaction (waiting for symptoms to appear) are displayed. Inaction is presented as a decoy, which has worse outcomes than either of the screening options. Due to this contrast, the inclusion of the decoy increases the appeal of the other screening options.

Enhanced Fear Appeals and Decoy Effect

Amir Goren, PhD

In this evaluation, 4 different versions of letters are being sent with mailers promoting colorectal cancer screening with an at-home test. The researchers hypothesize that the use of behavioral nudges in the message should lead to increased colorectal cancer screening (either with the at-home test or a colonoscopy).

Colorectal cancer (CRC) is the third most common cancer diagnosed in the US. Mailing fecal immunochemical (FIT) kits to at-risk patients is an effective way of increasing CRC testing uptake, as this test can be done at home and is less intrusive compared to colonoscopies. As part of an existing program, the health system mails FIT kits to eligible patients each year. Although this test needs to be conducted annually, not everyone who receives the test kit returns the kits for processing. In this study, the researchers aim to test different letters with the goal of encouraging the use of FIT kits or scheduling a colonoscopy.

As part of this study, the kits are mailed with everything the patient will need to conduct the test at home and mail a sample back to the hospital. It also includes an introductory letter informing the patient about the program and inviting them to use the kit. The researchers are comparing a standard version of the introductory letter against 3 versions that include different combinations of behavioral nudges, specifically framing effects (loss, default, decoy) and fear appeals.

Participants and providers are not aware of the different letter versions.

Evaluation of Letters Promoting Colorectal Cancer Testing

Evaluation of Letters Enhanced With Behavioral Nudges to Promote Colorectal Cancer Testing Through Fecal Immunochemical Tests or Colonoscopies

Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings. The PI did not examine or analyze any data from this study prior to this registration.

Binary variable indicating whether a valid FIT kit was returned for testing

Binary variable indicating whether a colonoscopy was ordered

Binary variable indicating whether a valid FIT kit was returned for testing (a longer time frame allows for late responses)

Binary variable indicating whether a colonoscopy was ordered (a longer time frame allows for late responses)

Binary variable indicating whether the test was positive or negative (if FIT kit was returned)

Binary variable indicating whether the colonoscopy was completed (if colonoscopy was ordered)

Binary variable indicating whether the test was positive or negative (if colonoscopy was completed)

Geisinger Clinic

Program Director, Behavioral Insights Team

Skin and Connective Tissue Diseases

Breast Neoplasms

Patients in this arm will receive a postcard with words and an image, typical of outreach in prior years, encouraging them to schedule their annual mammograms.

Patients in this arm will receive a letter from the Geisinger Health Plan (on Geisinger letterhead) noting that they're overdue for a mammogram and encouraging them to schedule.

Patients in this arm will receive a call from an auto-dialer with a message noting that they're overdue for a mammogram and encouraging them to schedule.

Patients in this arm will receive a call from a Geisinger Health Plan representative noting that they're overdue for a mammogram and encouraging them to schedule (and helping them schedule if they are interested).

Postcard with phone number to call for help scheduling a mammogram.

Postcard

Letter with phone number to call for help scheduling a mammogram.

Auto-dialer with option to press button for help scheduling a mammogram.

Auto-dialer

Live call offering help scheduling a mammogram.

Live call

Gail Rosenbaum, PhD

The project aims to evaluate four different versions and modalities of interventions encouraging mammogram screening among all eligible women due or overdue for screening. The evaluation will compare among the following forms of outreach to help determine whether (a) live calls are more effective at increasing mammogram screening than other forms of outreach and (b) each form of outreach is more effective than no outreach: (1) a postcard, (2) a letter, (3) an auto-dialer phone message, and (4) a live call from a care gaps team. The interventions will be rolled out over many months, allowing for comparisons of effectiveness against those who have not yet been contacted.

Each intervention will be rolled out to only a subset of the total population each month, such that all patients will receive one of the interventions over the course of 7 months. Active arms will be compared contemporaneously against a passive control group consisting of active arm participants for whom the intervention has not yet begun, as well as a random subset of participants who are excluded before the future intervention begins.

Mammogram Mail- and Phone-based Interventions

Randomized Comparison of Mail- and Phone-based Interventions Promoting Mammogram Screening

Data with no personally identifiable information will be made available to other researchers on the Open Science Framework for transparency. This will include the essential data and code needed to replicate the analysis that yielded reported findings.

Record of completed mammogram (yes/no), for comparing across postcards, letters, and auto-dialer messages

Record of high malignancy risk (yes/no), for comparing across different modalities of outreach

Appointment scheduled for mammogram, among patients visiting Geisinger clinics (yes/no)

Record of completed mammogram (yes/no), for comparing postcards, letters, and auto-dialer messages with live calls

Record of completed mammogram (yes/no), for comparing postcards, letters, auto-dialer messages, and live calls with controls

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Comparing Methods of Recall for Cancer Screening in Primary Care: a Pragmatic Clinical Trial	NCT02457143	Early Detection... Cancer Socioeconomic S...	Letter Phone call	21 Years - 74 Years	Unity Health Toronto
Maine Lung Cancer Coalition: Using CHWs for the Annual Lung Cancer Screening Reminder	NCT04007458	Lung Cancer	Letter Community Healt...	55 Years - 80 Years	MaineHealth
Comparing Methods of Recall for Cancer Screening in Primary Care: a Pragmatic Clinical Trial	NCT02457143	Early Detection... Cancer Socioeconomic S...	Letter Phone call	21 Years - 74 Years	Unity Health Toronto
Evaluation of Letters Promoting Colorectal Cancer Testing	NCT04548765	Cancer Colorect...	Letter Loss Frame and ... Transparency Default Effect ... Enhanced Fear A...	18 Years -	Geisinger Clinic
Maine Lung Cancer Coalition: Using CHWs for the Annual Lung Cancer Screening Reminder	NCT04007458	Lung Cancer	Letter Community Healt...	55 Years - 80 Years	MaineHealth
Mammogram Mail- and Phone-based Interventions	NCT05853848	Breast Cancer	Postcard Letter Auto-dialer Live call	51 Years - 74 Years	Geisinger Clinic

Spots Global Cancer Trial Database for letter

Every month we try and update this database with for letter cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Spots Global Cancer Trial Database for letter

Every month we try and update this database with for letter cancer trials from around the world to help patients and their families find trials that might be right for them. We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.

Every month we try and update this database with for letter cancer trials from around the world to help patients and their families find trials that might be right for them.
We offer this 100% free of charge and do not endorse any of the trials listed here, we hope it helps you or a loved one.