title: Financial Incentives for Promoting Colorectal Cancer Screening: A Randomized, Comparative Effectiveness Trial.
abstract: Offering financial incentives to promote or "nudge" participation in cancer screening programs, particularly among vulnerable populations who traditionally have lower rates of screening, has been suggested as a strategy to enhance screening uptake. However, effectiveness of such practices has not been established. Our aim was to determine whether offering small financial incentives would increase colorectal cancer (CRC) screening completion in a low-income, uninsured population.
  
  
  
  We conducted a randomized, comparative effectiveness trial among primary care patients, aged 50-64 years, not up-to-date with CRC screening served by a large, safety net health system in Fort Worth, Texas. Patients were randomly assigned to mailed fecal immunochemical test (FIT) outreach (n=6,565), outreach plus a $5 incentive (n=1,000), or outreach plus a $10 incentive (n=1,000). Outreach included reminder phone calls and navigation to promote diagnostic colonoscopy completion for patients with abnormal FIT. Primary outcome was FIT completion within 1 year, assessed using an intent-to-screen analysis.
  
  
  
  FIT completion was 36.9% with vs. 36.2% without any financial incentive (P=0.60) and was also not statistically different for the $10 incentive (34.6%, P=0.32 vs. no incentive) or $5 incentive (39.2%, P=0.07 vs. no incentive) groups. Results did not differ substantially when stratified by age, sex, race/ethnicity, or neighborhood poverty rate. Median time to FIT return also did not differ across groups.
  
  
  
  Financial incentives, in the amount of $5 or $10 offered in exchange for responding to mailed invitation to complete FIT, do not impact CRC screening completion.
authors.affiliation: San Diego Veterans Affairs Healthcare System, San Diego, California, USA.|Department of Internal Medicine, Division of Gastroenterology, and the Moores Cancer Center, University of California San Diego, San Diego, California, USA.
authors.forename: Samir
authors.initials: S
authors.lastname: Gupta
authors.affiliation: Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas, USA.
authors.forename: Stacie
authors.initials: S
authors.lastname: Miller
authors.affiliation: Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Koch
authors.affiliation: UT Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, Texas, USA.
authors.forename: Emily
authors.initials: E
authors.lastname: Berry
authors.affiliation: University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.
authors.forename: Paula
authors.initials: P
authors.lastname: Anderson
authors.affiliation: University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Sandi L
authors.initials: SL
authors.lastname: Pruitt
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Borton
authors.affiliation: Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Amy E
authors.initials: AE
authors.lastname: Hughes
authors.affiliation: Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carter
authors.affiliation: Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas, USA.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Hernandez
authors.affiliation: Department of Family Medicine, John Peter Smith Health Network, Fort Worth, Texas, USA.
authors.forename: Helen
authors.initials: H
authors.lastname: Pozos
authors.affiliation: University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.|Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Halm
authors.affiliation: Rady School of Management, University of California San Diego, La Jolla, California, USA.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Gneezy
authors.affiliation: Rady School of Management, University of California San Diego, La Jolla, California, USA.
authors.forename: Alicea J
authors.initials: AJ
authors.lastname: Lieberman
authors.affiliation: University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Celette
authors.initials: C
authors.lastname: Sugg Skinner
authors.affiliation: UT Southwestern Medical Center, Moncrief Cancer Institute, Fort Worth, Texas, USA.|University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.|Department of Clinical Sciences, UT Southwestern Medical Center, Dallas, Texas, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Argenbright
authors.affiliation: University of Texas Southwestern Medical Center Harold C. Simmons Cancer Center, Dallas, Texas, USA.|Department of Epidemiology, Genetics, & Environmental Science, University of Texas School of Public Health Dallas Regional Campus, Dallas, Texas, USA.
authors.forename: Bijal
authors.initials: B
authors.lastname: Balasubramanian
mesh_terms: D003113:Colonoscopy / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005243:Feces / Q000737:chemistry; D005260:Female; D006801:Humans; D007120:Immunochemistry / Q000706:statistics & numerical data; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009042:Motivation; D011203:Poverty