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Penn Medicine News: Low Effort, High Reward — How Making Choices Easy Pays Off in Clinical Trials

From Penn Medicine News: “We thought there would be a relatively small effect. But we knew that an effect of that size would save lives.” That’s what Shivan Mehta, MD, associate chief innovation officer at Penn Medicine and an assistant professor of Medicine in the Perelman School of Medicine at the University of Pennsylvania, thought heading into a trial aimed at improving colorectal cancer screenings in a historically under-served community. The idea was to make the screenings as simple as possible for patients at a local community health center that primarily served people of color — through mailing fecal immunochemical test (FIT) kits directly to patients instead of making them proactively sign up for them or come in for more involved colonoscopies. The study, which ran in 2018, was calibrated so that a relative improvement of 60 percent — not a miniscule accomplishment — would be considered statistically significant when compared to the standard method of sending text reminders to patients overdue for the screenings. But Mehta and his fellow researchers — including the study’s eventual lead author, Sarah Huf, MBBS, a former Commonwealth Fund Fellow at Penn — didn’t find a “relatively small effect.” They found a giant one. The rate of patients whose kits were mailed home improved over the standard texting group by 1,000 percent. It was a tenfold increase. “While we knew that mailing FIT kits was an effective form of outreach, we did not realize how much better it would be in this population, partially because the standard method of sending a text alone had such a low response,” said Mehta. “We needed to take extra steps to reduce the burden of responding.” When researchers get results like this, it’s imperative to capitalize on them. Applying the lessons learned — pushing an easy, low-effort choice — to future work can expand the already impressive positive impact achieved, particularly for underserved patients. Read more at Penn Medicine News.