Cancer Evaluations During the COVID-19 Pandemic: An Observational Study Using National Veterans Affairs Data

Meyer, Ashley N. D.; Singh, Hardeep; Zimolzak, Andrew J.; Wei, Li; Choi, Debra T.; Marinez, Abigail; Murphy, Daniel R.

doi:10.1016/j.amepre.2022.07.004

Cited by 2 publications

(3 citation statements)

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“…For example, when employers changed the default for retirement savings from an opt-in to an opt-out approach, employee participation in retirement savings significantly increased. 2 Several studies have shown how opt-out approaches are associated with medical decisions. The current default option for cancer screening is to not participate unless a patient opts in.…”

Section: Discussionmentioning

confidence: 99%

“…Over 280 000 individuals who receive care from the Veterans Health Administration (VHA) are eligible for breast cancer screening (BCS), and only 66% are up to date on screening . Since the COVID-19 pandemic, BCS rates have been persistently lower within the VHA compared with before the pandemic . Barriers to BCS among veterans include scheduling, long wait times, and lack of on-site mammography, with the need to coordinate care with outside facilities .…”

Section: Introductionmentioning

confidence: 99%

“…1 Since the COVID-19 pandemic, BCS rates have been persistently lower within the VHA compared with before the pandemic. 2 Barriers to BCS among veterans include scheduling, long wait times, and lack of on-site mammography, with the need to coordinate care with outside facilities. [3][4][5] Population-based outreach for preventive care (in which patients due for screening are notified outside a primary care visit) may help to address barriers to BCS.…”

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Automated Opt-Out vs Opt-In Patient Outreach Strategies for Breast Cancer Screening

Marcotte,

Deeds,

Wheat

et al. 2023

JAMA Intern Med

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ImportanceOptimal strategies for population-based outreach for breast cancer screening remain unknown.ObjectiveTo evaluate the effect on breast cancer screening of an opt-out automatic mammography referral strategy compared with an opt-in automated telephone message strategy.Design, Setting, and ParticipantsThis pragmatic randomized clinical trial was conducted from April 2022 to January 2023 at a single Veterans Affairs (VA) medical center. Participants were female veterans aged 45 to 75 years who were eligible for breast cancer screening and enrolled in VA primary care.InterventionVeterans were randomized 1:1 to receive either an automatic mammography referral (opt-out arm) or an automated telephone call with an option for mammography referral (opt-in arm).Main Outcomes and MeasuresThe primary outcome was completed mammography 100 days after outreach. Secondary outcomes were scheduled or completed mammography by 100 days after outreach and referrals canceled if mammography was not scheduled within 90 days. Both intention-to-treat analyses and a restricted analysis were conducted. The restricted analysis excluded veterans who were unable to be reached by telephone (eg, a nonworking number) or who were found to be ineligible after randomization (eg, medical record documentation of recent mammography).ResultsOf 883 veterans due for mammography (mean [SD] age, 59.13 [8.24] years; 656 [74.3%] had received prior mammography), 442 were randomized to the opt-in group and 441 to the opt-out group. In the intention-to-treat analysis, there was no significant difference in the primary outcome of completed mammography at 100 days between the opt-out and opt-in groups (67 [15.2%] vs 66 [14.9%]; P = .90) or the secondary outcome of completed or scheduled mammography (106 [24.0%] vs 84 [19.0%]; P = .07). A higher number of referrals were canceled in the opt-out group compared with the opt-in group (104 [23.6%] vs 24 [5.4%]; P &lt; .001). The restricted analysis demonstrated similar results except more veterans completed or scheduled mammography within 100 days in the opt-out group compared with the opt-in group (102 of 388 [26.3%] vs 80 of 415 [19.3%]; P = .02).Conclusions and RelevanceIn this randomized clinical trial, an opt-out population-based breast cancer screening outreach approach compared with an opt-in approach did not result in a significant difference in mammography completion but did lead to substantially more canceled mammography referrals, increasing staff burden.Trial RegistrationClinicalTrials.gov Identifier: NCT05313737

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Section: Discussionmentioning

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Section: Introductionmentioning

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