Financial Incentives to Improve Colorectal Cancer Screening—Time to Cut Our Losses

Abstract

Colorectal cancer (CRC) screening reduces mortality from this second leading cause of cancer deaths in the United States. 1 However, only 69% of eligible adults in the United States are up to date with CRC screening, with lower rates of screening among racial/ethnic minority groups and individuals with lower socioeconomic status. 1 Therefore, evidence-based interventions to improve CRC screening adherence are needed, especially interventions that address screening disparities.In their systematic review and meta-analysis of randomized clinical trials (RCTs), Facciorusso et al, 2 evaluated the benefit of financial incentives for CRC screening uptake. This study included RCTs of adults who were eligible for CRC screening and received various financial incentives (fixedamount or lottery-based incentives that were unconditional or conditional on screening completion) or no financial incentives (screening reminders or mailed outreach alone). The primary outcome of interest was CRC screening completion using recommended tests within 12 months of receiving the intervention. The authors analyzed 8 RCTs, which represented 110 644 patients (53 444 were offered financial incentives, and 57 200 were not offered financial incentives). These US-based studies, which were published between 2014 and 2020, included screening with fecal occult blood test or fecal immunochemical test (FIT; 4 RCTs), colonoscopy (3 RCTs), or other approved screening tests (1 RCT

Examining the relationship between household wealth and colorectal cancer screening behaviors among U.S. men aged 45–75

“…These results contrast with the finding from prior research that higher household wealth increases utilization of preventive services such as CRC screening ( Morales et al, 2004 ; Solmi et al, 2015 ). However, our findings do align with published studies suggesting that money is not a key determinant of having completed a CRC screening exam ( Issaka & Dominitz, 2021 ; Levin, 2017 ). For example, offering a financial incentive to adults who are eligible for CRC screening has not been consistently found to increase screening uptake ( Facciorusso et al, 2021 ), although larger incentives (e.g., $100) that offset some of the costs associated with screening may help to some degree compared with smaller incentives (e.g., $5, $10; Mehta et al, 2017 ).…”

“…Therefore, a myriad of factors contribute to CRC screening test completion and increasing uptake requires addressing more than one component such as reducing out-of-pockets costs, reminding patients to get screened, providing transportation, and increasing provider delivery ( Carethers & Doubeni, 2020 ; Guide to Community Preventive Services, 2016 ). It may be that greater wealth facilitates the completion a CRC screening test for those who are already considering undergoing CRC screening ( Issaka & Dominitz, 2021 ).…”

Community Health Center Staff Perspectives on Financial Payments for Social Care

“…In fact, there already is mixed evidence about the effectiveness-and sustained effectiveness-of financial incentives on the uptake of more common clinical practices, such as alcohol screening, 41 diabetes management, 42 immunization administration, [43][44][45] and colorectal screening. [46][47][48] One study on pay-for-performance incentives, specifically, noted that they also can have a wide range of unintended consequences, including leading to "box-ticking" or rote activities that do not contribute to meaningful changes in the quality of care. 49 In our interviews, despite believing that social care was consistent with their overarching organizational mission, staff described multiple, deeply embedded barriers to social care, which together suggest that financial incentives are likely to be less impactful for social care than for other clinical care activities.…”

“…A logical next question, however, is whether increasing awareness of financial incentives would then lead clinical teams to adopt social care practices. In fact, there already is mixed evidence about the effectiveness—and sustained effectiveness—of financial incentives on the uptake of more common clinical practices, such as alcohol screening, 41 diabetes management, 42 immunization administration, 43–45 and colorectal screening 46–48 . One study on pay‐for‐performance incentives, specifically, noted that they also can have a wide range of unintended consequences, including leading to “box‐ticking” or rote activities that do not contribute to meaningful changes in the quality of care 49 …”