Clinical trial NCT03124316: Testing a Behavioural Approach to Improving Cancer Screening Rates
Official title: Testing a Behavioural Approach to Improving Cancer Screening Rates Through Increased Use of Primary Care Feedback Reports
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Early Detection of Cancer
Clinical Trial
Lead sponsor: Women's College Hospital
Sponsor class: OTHER
Collaborators: name: Ontario Institute for Cancer Research
name: Cancer Care Ontario
name: Ottawa Hospital Research Institute
name: Laval University
First posted: 2017-04-21
Enrollment: 5525
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: FACTORIAL
Intervention 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.
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: 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: 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.

Eligibility criteria: 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.

Primary outcomes:
measure: SAR access
timeFrame: 4 months
Secondary outcomes:
measure: SAR access rate
timeFrame: 4 months
measure: Adherence to screening guidelines for breast, colon, and cervical cancer in patients of eligible PCPs
timeFrame: 4 months
Other outcomes:
measure: Process Measures: contact made with Cancer Care Ontario
timeFrame: 4 months
Locations:
city: Toronto
country: Canada
facility: Cancer Care Ontario
state: Ontario
Study officials:
affiliation: Women's College Hospital
name: Noah Ivers, MD, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: 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.