Need to encourage patients to screen for colon cancer? Try a lottery

Convincing patients to do an often-dreaded colon cancer screening test could just take a little extra nudge, such as a chance to win $50, new research found.

Patients who were told they had a 1-in-10 chance of winning $50 were more likely to complete home stool blood tests that help screen for colon cancer, according to a new study led by a researcher at the VA Ann Arbor Healthcare System and University of Michigan in Ann Arbor. The findings appeared in a special issue of Annals of Internal Medicine (2014; doi:10.7326/M13-3015).

“Our study is another example of how modest financial incentives may go a long way in improving health behaviors and health care quality,” said Jeffrey Kullgren, MD, MS, MPH, a research scientist in the VA Ann Arbor Healthcare System, an assistant professor of internal medicine at the U-M Medical School and a former Robert Wood Johnson Foundation Clinical Scholar.

“Integrating a small lottery incentive into usual care is a low cost tool with potential to promote patients' use of a service proven to save lives by catching cancer early.”

Officially called a fetal occult blood test (FOBT), the home kit requires patients to take a sample of their bowel movement and mail it to a lab. The test helps detect hidden, microscopic blood in stool that may be an early sign of abnormal growths (polyps) or cancer in the colon. It is the least expensive way to screen for colon cancer and is recommended annually for people older than 50 years, but only about one-third of patients who are prescribed the home kit actually complete it.

Researchers wanted to see what price might help reverse the trend, looking at whether flat dollar amounts of up to $20, a chance to win $50, or raffle for $500 could be an effective incentive. The $50 lottery approach had the greatest impact, increasing the test completion rate by 20%.

The study was done at the Philadelphia Veterans Affairs Medical Center among 1,549 patients who were prescribed the blood stool test.

“Fecal occult blood tests are inexpensive and an effective way to find colon cancer early and save lives. It's up to the patient, however, to do this test at home and unfortunately completion rates are low,” said Kullgren, who is also a member of U-M's Institute for Healthcare Policy and Innovation.

“Our work supports growing evidence that low cost innovations may be under-utilized in health care. We need to explore more ways to identify how, when, and where financial incentives can improve prevention of chronic disease.”

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