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Nudge sent to the patient through text messaging.

Nudge sent to both provider through EHR, and to patient through text messaging.

Nudge directed to the patient with the aim of increasing the uptake of MRI in patients with extremely dense breasts

Patient nudge

Nudge directed to the provider with the aim of increasing ordering of MRI in patients with extremely dense breasts

Provider nudge

Anne Marie McCarthy, PhD

The goal of this study is to increase MRI utilization among women with extremely dense breasts. The main question it seeks to answer is whether nudging of the provider, patient, or both increases the uptake of MRI among this group, and whether this effect differs between Black and White women.

Women with dense breasts have 3-5-fold increased risk for breast cancer as women without dense breasts. Dense breast tissue can "mask" small tumors, leading to reduced mammography sensitivity. Recent randomized controlled trials demonstrate that supplemental breast MRI screening improves detection of small, invasive cancers that are not detected by mammography. In January 2022, a Pennsylvania law went into effect mandating insurance coverage of supplemental screening for women with extremely dense breasts. Currently only a small fraction of eligible women with extremely dense breasts are receiving supplemental breast MRI screening. Clinical pathways to identify patients who are eligible for insurance coverage of supplemental breast MRI screening and communicate this option to patients and providers are needed to ensure equitable access to supplemental screening. This study therefore proposes a stepped wedge cluster randomized clinical trial to determine whether electronic health record (EHR) and secure text message nudges increase utilization of supplemental breast MRI screening among eligible women with extremely dense breasts.

Improving Utilization of Supplemental Breast MRI Screening for Women With Extremely Dense Breasts

Whether a breast MRI is ordered and/or scheduled within 6 months of receiving a nudge.

Whether an MRI is ordered within 6 months of receiving a nudge. Analyzed separately from scheduling.

Whether an MRI is scheduled within 6 months of receiving a nudge. Analyzed separately from ordering.

Whether an MRI is completed within 6 months of receiving a nudge

False-positive rate among those women who schedule and undergo MRI

Cancer detection rate among those women who schedule and undergo MRI

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization	Link
Improving Utilization of Supplemental Breast MRI Screening for Women With Extremely Dense Breasts	NCT05787249	Breast Cancer	Patient nudge Provider nudge	40 Years - 74 Years	Abramson Cancer Center at Penn Medicine
Improving Utilization of Supplemental Breast MRI Screening for Women With Extremely Dense Breasts	NCT05787249	Breast Cancer	Patient nudge Provider nudge	40 Years - 74 Years	Abramson Cancer Center at Penn Medicine

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