Testing a Behavioural Approach to Improving Cancer Screening Rates

Study Overview
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Brief Summary
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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.

Detailed Description
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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.

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

Conditions
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Early Detection of Cancer, Clinical Trial

Intervention / Treatment
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* Behavioral: Anticipated regret
* Behavioral: Material incentive
* Behavioral: Problem solving


Participation Criteria
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Eligibility Criteria
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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.
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Factorial Assignment
Interventional Model Description: We will test three components of reminders to family physicians that could be embedded independently, in combinations of two, and all together in a reminder email. Family physicians will be randomly allocated to one of 8 experimental conditions. Each experimental condition comprises a different combination of the behaviour change techniques featured in the redesigned email reminder.
Masking: Double


Arms and Interventions

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

What is the study measuring?
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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 |