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How Do Financial Incentives Affect CRC Screening Completion?

Financial incentives are often successful at increasing preventive health behaviors, like exercising or smoking cessation, but a recently published study by PC3I’s Alicia Clifton, MDP, Kate Rendle, PhD, MSW, MPH, and Shivan Mehta, MD, MBA, MSHP explored why this behavioral intervention has shown limited impact on colorectal cancer screening to date.

This study was conducted as part of a four-arm trial in which patients due for screening were mailed fecal immunochemical test (FIT) kits, an at-home screening tool for colorectal cancer. All patients received the mailed FIT kit, but depending on which study arm patients were assigned, they received no incentive at all, an unconditional incentive ($10) with the kit, a conditional incentive ($10) only if the kit was completed, or chance to receive $100 (1-in-10 lottery) if the kit was completed. The financial incentives, however, did not have a significant effect on at-home screening, with less than one third of patients completing the kit across the board. The researchers wanted to understand why.

They conducted follow-up interviews to examine patients’ attitudes and beliefs related to screening and how financial incentives may or may not affect their decision to get screened. Of 60 interview participants, the majority (68%) of which identified as Black, 82% shared that incentives would not change their decision, and of those, most expressed that they would complete the FIT kit regardless of whether there was an incentive in place. The perceived benefits from screening itself were viewed as sufficient motivators, and authors concluded that other interventions like reminders might better address their reasons for low completion. There was a small set of participants who did convey that a financial incentive might motivate them to get screened. These patients were less likely than the first group to perceive a health benefit to getting screened. With lower perceived benefits, the authors concluded that financial incentives might be an effective way to provide sufficient motivation for screening.

These nuances in motivations suggest that financial incentives may be more impactful if they are adapted to patient screening beliefs. Tailoring the type of colorectal cancer screening intervention based on such differences may serve as an effective way to increase CRC screening rates.


The paper Exploring Why Financial Incentives Fail to Affect At-home Colorectal Cancer Screening: a Mixed Methods Study, was authored by Alicia Clifton, MDP; Shivan Mehta, MD, MBA, MSHP; Jocelyn Wainwright, MS; Shannon Ogden, MPH; Chelsea Saia, MPH; and Katharine Rendle, PhD, MSW, MPH, and appeared in the Journal of General Internal Medicine on January 17, 2022.

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