Testing a Behavioural Approach to Improving Cancer Screening Rates

Testing a Behavioural Approach to Improving Cancer Screening Rates Through Increased Use of Primary Care Feedback Reports

Family doctors can play a critical role in successfully arranging cancer screening tests to occur, especially if they know which patients are due for these tests. However, they don't always interact with or take advantage of registry data to this end. For example, in Ontario, the Screening Activity Report provides exactly this information to family doctors, helping them identify their patients who are overdue for screening. Unfortunately, less than half of family doctors regularly use the Screening Activity Report even though they get monthly email reminders. One possible reason is that the reminders they receive are not designed to compel action. They are easy for family doctors to miss or dismiss. This study will compare multiple different ways of designing the reminders. The different versions of the email are tested in a 2^3 factorial trial testing three behaviour change techniques to see which ones will lead to more family physicians interacting with the Screening Activity Report and at increasing the number of patients that get all the appropriate screening tests for cervical, breast, and/or colon cancer.

Study Overview

• Status: Completed
• Conditions: Clinical Trial; Early Detection of Cancer
• Intervention / Treatment: Behavioral: Anticipated regret; Behavioral: Material incentive; Behavioral: Problem solving

Detailed Description

Screening is an important way to prevent cancer-related death, but many Ontarians do not receive guideline-recommended screening for cervical, breast, and colon cancer. Family physicians can play a critical role in successfully increasing screening rates. A recent evaluation by members of our team suggests that Screening Activity Report (SAR) use is associated with improved cancer screening, but there remains substantial room for improvement. For the SAR to reach its full potential to decrease cancer-related death by improving screening rates, family physicians must regularly access it and take the appropriate actions. Currently, family physicians receive monthly email reminders, which state that new data are available, but do not describe the benefits of the SAR for physicians or their patients. It is easy to imagine how a busy doctor would fail to act upon such emails, resulting in suboptimal use of the SAR and leading to avoidable delays in cancer screening, and management. Indeed, CCO data show that less than half of recipients attend to this email and <7% click through to the SAR. The objectives for this trial are to compare different versions of the reminders in a randomized trial to identify the features that most increase use of the SAR. This is a pragmatic, 2^3 factorial trial, comparing behaviour change techniques incorporated within email reminders to doctors increase their use of the SAR. Participants are those who are already sent monthly emails by CCO regarding the SAR. The trial will randomly assign participants to one of eight modified emails to determine which content is most effective at driving SAR-use over 4 months. With an expected sample size of over 5700 family physicians, we anticipate power to see differences of 3% across experimental conditions.

• Study Type: Interventional
• Enrollment (Actual): 5525
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Canada
  • Ontario
    • Toronto, Ontario, Canada, M5G 2L7
      • Cancer Care Ontario

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: ADULT; OLDER_ADULT; CHILD
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Family physicians are eligible if they have signed up for the SAR and already receive reminder emails as part of their registration process for the SAR with CCO.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: HEALTH_SERVICES_RESEARCH
• Allocation: RANDOMIZED
• Interventional Model: FACTORIAL
• Masking: DOUBLE

Number of Arms

8

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
NO_INTERVENTION: Email #1: FULLY TURNED OFF; No behavioural change techniques (BCTs) 'turned on' in the email. The email would contain only standardized content.
EXPERIMENTAL: Email #2: ANTICIPATED REGRET; Anticipated regret content + standardized content	Behavioral: Anticipated regret; Induce awareness of future regret about the unwanted behaviour
EXPERIMENTAL: Email #3: MATERIAL INCENTIVE; Material incentive content + standardized content	Behavioral: Material incentive; Inform that valued objects will be delivered if and only if that has been progress in performing the desired behaviours
EXPERIMENTAL: Email #4: PROBLEM SOLVING; Problem solving content + standardized content	Behavioral: Problem solving; Analyze or prompt the person to factors that influence the behaviour and select strategies that help overcome barriers
EXPERIMENTAL: Email #5: REGRET + INCENTIVE; Anticipated regret content + Material incentive content + standardized content	Behavioral: Anticipated regret; Induce awareness of future regret about the unwanted behaviour; Behavioral: Material incentive; Inform that valued objects will be delivered if and only if that has been progress in performing the desired behaviours
EXPERIMENTAL: Email #6: REGRET + PROBLEM SOLVING; Anticipated regret content + Problem solving content + standardized content	Behavioral: Anticipated regret; Induce awareness of future regret about the unwanted behaviour; Behavioral: Problem solving; Analyze or prompt the person to factors that influence the behaviour and select strategies that help overcome barriers
EXPERIMENTAL: Email #7: INCENTIVE + PROBLEM SOLVING; Material incentive content + Problem solving content + standardized content	Behavioral: Material incentive; Inform that valued objects will be delivered if and only if that has been progress in performing the desired behaviours; Behavioral: Problem solving; Analyze or prompt the person to factors that influence the behaviour and select strategies that help overcome barriers
EXPERIMENTAL: Email #8: ALL BCTs; Anticipated regret content + Material incentive content + Problem solving content + standardized content	Behavioral: Anticipated regret; Induce awareness of future regret about the unwanted behaviour; Behavioral: Material incentive; Inform that valued objects will be delivered if and only if that has been progress in performing the desired behaviours; Behavioral: Problem solving; Analyze or prompt the person to factors that influence the behaviour and select strategies that help overcome barriers

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
SAR access	The primary outcome will be whether eligible family physicians access the SAR during the 4 months of the trial (Yes/No)	4 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
SAR access rate	Number of times the SAR was accessed	4 months
Adherence to screening guidelines for breast, colon, and cervical cancer in patients of eligible PCPs	Proportion of patients meeting screening guidelines for breast, colon, and cervical cancer; and efforts made by participants to access the SAR-use	4 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Process Measures: contact made with Cancer Care Ontario	Number of calls to CCO contact centre regarding the SAR	4 months

Collaborators and Investigators

• Sponsor: Women's College Hospital
• Collaborators: Ottawa Hospital Research Institute; Cancer Care Ontario; Laval University; Ontario Institute for Cancer Research

Publications and helpful links

General Publications

• Vaisson G, Witteman HO, Bouck Z, Bravo CA, Desveaux L, Llovet D, Presseau J, Saragosa M, Taljaard M, Umar S, Grimshaw JM, Tinmouth J, Ivers NM. Testing Behavior Change Techniques to Encourage Primary Care Physicians to Access Cancer Screening Audit and Feedback Reports: Protocol for a Factorial Randomized Experiment of Email Content. JMIR Res Protoc. 2018 Feb 16;7(2):e11. doi: 10.2196/resprot.9090.

Helpful Links

• CCO SAR website

Study record dates

Study Major Dates

• Study Start (ACTUAL): May 10, 2017
• Primary Completion (ACTUAL): September 30, 2017
• Study Completion (ACTUAL): September 30, 2017

Study Registration Dates

• First Submitted: April 18, 2017
• First Submitted That Met QC Criteria: April 18, 2017
• First Posted (ACTUAL): April 21, 2017

Study Record Updates

• Last Update Posted (ACTUAL): March 22, 2018
• Last Update Submitted That Met QC Criteria: March 21, 2018
• Last Verified: March 1, 2018

More Information

Terms related to this study

• Other Study ID Numbers: 2017-004-E

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No