A Randomized Controlled Trial of Opt-in Versus Opt-Out Colorectal Cancer Screening Outreach

Abstract

Mailed CRC screening outreach providing an option to opt-out had significantly higher participation rates than opt-in messaging. Opt-out messaging approaches can boost participation in population health outreach efforts.

The effect of the Affordable Care Act on patient out-of-pocket cost and use of preventive cancer screenings in Massachusetts

“…procrastination, information aversion, etc.) (Mehta et al, 2018; Kessler et al, 2018; Volpp and Asch, 2017), and the reductions in cost may not have been enough to overcome these barriers for some patients.…”

Effect of Sequential or Active Choice for Colorectal Cancer Screening Outreach

“…There are also some limitations to this study. First, we did not have an arm that focused on mailed FIT only, although there are 2 concurrent studies 20,31 in the same health system that provide information about response rates. Second, we only focused on choice for mailed CRC screening outreach, so we were not able to fully address the differences in screening options.…”

The Effects of Different Invitation Schemes on the Use of Fecal Occult Blood Tests for Colorectal Cancer Screening: Systematic Review of Randomized Controlled Trials

“…Quality assessment with the RoB 2 tool resulted in a low risk of bias for 14 studies [ 10 , 11 , 13 , 14 , 16 , 19 , 26 , 28 , 32 , 34 , 38 , 39 , 40 , 42 ], 19 studies with some concerns [ 12 , 15 , 17 , 18 , 20 , 21 , 22 , 23 , 24 , 25 , 27 , 29 , 30 , 31 , 33 , 36 , 37 , 41 , 43 ], and one [ 35 ] at high risk of bias ( Table S1 ). Concerns were mainly due to the ambiguity of randomization and baseline characteristics (domain 1 “randomization process”), and a lack of pre-specified protocol or analysis plan (domain 5 “selection of the reported result”).…”

“…Ten were performed in national screening programs [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 ], and nine in other population-based settings (e.g., within a specific region or health maintenance organization) [ 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 ]. Primary care settings ( n = 7) included practices [ 29 , 30 ], clinics [ 31 ], university clinics [ 32 , 34 ], or health centers [ 33 , 35 ], and most invitations were sent on behalf of the physicians. Eight studies (all from the USA) included predominantly low-income or uninsured individuals in safety net [ 37 , 39 , 43 ], federally qualified health centers (FQHC) [ 36 , 38 , 41 , 42 ], and Medicaid settings [ 40 ].…”

“…Primarily, the health system sent the invitation. In most studies, no invitation was sent to individuals with recent screening activities, e.g., gFOBT/FIT in the past year, endoscopic screening within up to 10 years [ 13 , 16 , 19 , 23 , 24 , 25 , 26 , 28 , 32 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ], or (family-) history of CRC or other severe medical issues [ 10 , 15 , 16 , 19 , 23 , 24 , 25 , 28 , 29 , 32 , 33 , 34 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. Main results are presented by different intervention approaches in Figure 2 and Figure 3 , and by different settings in Tables S2–S5 .…”