Cash isn't king when it comes to encouraging patients to undergo preventive medical treatment, according to a study released Friday.
Researchers mailed nearly 900 patients at-home colorectal cancer screening kits, giving four groups different incentives for completing the test. One group received $10 with the kit; the second only scored $10 after completing the screening. A third group was entered into a lottery with a one in 10 chance of winning $100, and the last had no financial incentive attached to the preventive screening.
Colorectal cancer is the third leading cause of cancer-related death in the U.S., projected to cause more than 51,000 deaths in 2019 , according to the American Cancer Society. A major contributor to the high mortality rate is likely the low screening rate.
In the study published in JAMA Network Open on Friday, 24% of all trial participants mailed back their completed tests within two months of receiving the kit and 29% within six months. There was no significant increase in completion rates among patients who got incentives and those who got nothing.
At the two-month mark, 27% of patients that immediately got $10 with no conditions completed the test, compared to 26% that got no incentive, 23% who got the money only after they completed screening, and 18% who were placed in the lottery to win $100.
Results were similar after six months, where 33% of the immediate incentive group completed their colorectal screening compared with 32% who received no incentive. Approximately 27% of patients that got $10 on condition of completing the test mailed back their kits, compared to 24% among the group that were placed in the lottery.
The clinical trial patients ranged between ages 50 and 75 and received their kits from December 2015 to September 2018.
Lead study author Dr. Shivan Mehta, associate chief innovation officer at Penn Medicine, said the findings indicate there need to be a combination of incentives to boost compliance. Relying on a single approach won't get the best results.
"Often people think there are certain things that work in terms of increasing response rates and screening rates, but it's important to test these things in context to see if it's actually making an impact or not," Mehta said.
Mehta pointed out that colorectal cancer screening increased when patients received at-home testing kits rather than having to go to a clinic. Convenience could play an important role toward achieving greater compliance.
"This is a relatively high response rate for screening since we only reached out to patients who had not been previously up-to-date, despite having a primary care clinician," Shivan said.
Only 67% of eligible patients got colorectal cancer screening in 2016, well below the national target of 80%. The American Cancer Society has estimated that a colorectal screening rate of 80% would have prevented more than 200,000 deaths in 2018. Only 39% of colorectal cancer cases in 2018 were diagnosed at an early stage.
Colorectal cancer disproportionately affects African-American men, who had both the highest incidence rate at 58.3 cases for every 100,000 people in 2013 and the highest rate of death at 25.9 per 100,000 in 2014. By comparison, the average incidence rate for colorectal cancer among all men was 46.9 per 100,000 in 2013, and the mortality rate among all men in 2014 was 17.7 per 100,000.
Such disparity in outcomes has been one of the drivers among healthcare providers to seek better approaches toward incentivizing greater compliance to preventive care services like colorectal cancer screening, where early detection can increase the five-year survival rate by 90%.
"The hope is that systematic, population-based proactive outreach programs might be able to narrow a lot of these disparities and lessen the disparities that are created by social determinants of health," Mehta said.