Low effort, high reward: How making choices easy pays off in clinical trials

When researchers get highly favorable results, it’s imperative to capitalize on them. Applying the lessons learned to future work can expand the positive impact achieved.

“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, associate chief innovation officer at Penn Medicine and an assistant professor of medicine in the Perelman School of Medicine, thought heading into a trial aimed at improving colorectal cancer screenings in a historically underserved 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.

A stack of medical mail beside a cell phone and computer.

The study, which ran in 2018, was calibrated so that a relative improvement of 60%—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 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%. 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,” says 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.

That’s what the researchers did for a recent Penn Medicine study attempting to improve hepatitis C screening rates. For patients in the hospital who were due for a screening, a default order was automatically placed in the patient’s electronic health record. This trial, replacing a system that needed physicians to click once to opt in to a screening for overdue patients before, resulted in a near-doubling of screening rates. And it followed the FIT kit trial’s example before it: Low effort, high reward.

This story is by Frank Otto. Read more at Penn Medicine News.