A new study from the Perelman School of Medicine at the University of Pennsylvania has found that liver cancer screening rates among patients with cirrhosis nearly doubled when they received a mailed order from their specialist.
Interestingly, adding a $20 incentive to these mailed orders did not significantly impact the screening completion rates. The findings were published recently in Hepatology Communications.
Led by Shivan Mehta, MD, MBA, an associate professor of Gastroenterology and the associate chief innovation officer at Penn Medicine, the study focused on increasing liver cancer surveillance among high-risk patients.
Patients with cirrhosis are particularly vulnerable to hepatocellular carcinoma, a major cause of cancer deaths globally. The study’s goal was to find effective ways to encourage these patients to undergo crucial screening.
Conducted over 2020 and 2021, the research involved more than 500 diverse patients and spanned three distinct time periods.
When patients were mailed an order for an abdominal ultrasound, about 55% completed their screening within six months.
This was a significant increase compared to the 27% completion rate observed when screening was only offered during routine office visits.
The mailed letters included detailed information on the importance of ultrasounds for cirrhosis patients. Kenneth Rothstein, MD, the study’s lead author and a professor of Gastroenterology at Penn, emphasized the importance of early detection in improving survival rates.
He noted that currently, only 20% of cirrhosis patients in the U.S. are screened properly, leading to many preventable deaths.
The study employed the concept of “nudging” from behavioral science, aiming to make the right decision—the decision to get screened—easier for patients.
In addition to the standard mailed order, the researchers experimented with a $20 incentive just for opening the mail.
However, the completion rate in this incentive group was nearly the same as the non-incentive group, with 54.1% versus 54.5%, respectively.
Mehta pointed out the mixed results regarding financial incentives in preventive health activities. He suggested that patients might not be accustomed to receiving money from clinicians through mail, or perhaps larger or conditional incentives might be more effective.
This study builds upon Mehta’s previous research, which found that mailing colorectal cancer screening kits to patients’ homes was effective, regardless of financial incentives.
Another study by Mehta also showed the effectiveness of mailed reminders over electronic messaging for hepatitis C screening.
Mail appears to have a distinct advantage in reaching patients, especially considering the variable access to internet and smartphones.
Mehta stressed the importance of communicating with patients through the most accessible method for them, highlighting the effectiveness of traditional mailing in certain healthcare communications.
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The research findings can be found in Hepatology Communications.
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