Cancer-Screening Procrastination Can Be Deadly: a Nudge Lifts Compliance

At-home test for colorectal cancer delivered with a deadline

Our daily choices are often not the kindest to our future self. The exercise we skip, the less-healthy dietary choices we make, the cigarettes we smoke and even the retirement savings we don’t do — all carry significant risk for our future well-being. 

As does the less frequent, but just as consequential, choice to delay or skip preventive health care.

With an estimated 38% of Americans expected to be diagnosed with cancer, being able to take advantage of a screening test would seem like an obvious win to catch any disease sooner rather than later. Yet too few — 68% of whites, 65% of Blacks, 59% of Hispanics and 58% of Asians — are up to date on this periodic preventive test.

A real-word experiment that offered screening to more than 7,700 participants found that giving people a deadline to complete an at-home test for colorectal cancer was an effective nudge that boosted testing rates. Moreover, giving them a short deadline of one week was just as effective as imposing a deadline coupled with a monetary incentive.

A Better FIT for Better Outcomes

Until fairly recently, initial screening for colon cancer presented a slew of hurdles. Subjecting yourself to a bowel cleansing and fasting ahead of a colonoscopy or sigmoidoscopy — both typically involving sedation — can indeed feel like a big personal ask.

The development of an at-home test removed some of those hurdles. The fecal immunochemical test is an at-home test that requires collecting a small stool sample and mailing it in for testing. A FIT test provides an initial noninvasive screening for colon cancer. If a person receives a positive test, they then must undergo a diagnostic procedure such as a colonoscopy. However, if they receive a negative test, they simply need to do the FIT again the following year. Comfort of at-home use, simplicity of the test, and removing the need to travel to the clinic/take a day off work remove some big barriers to screening.

Increasing acceptance of the at-home tests has been the subject of considerable research.

Boosting FIT uptake

A team of researchers launched a field study to explore whether more people would follow through on an at-home FIT test if they were presented with a finite deadline and if an additional financial incentive might further increase uptake.

That team of researchers includes UCLA Anderson’s Alicea Lieberman; UC San Diego’s Ayelet Gneezy; University of Texas Southwestern Medical Center, Fort Worth’s Emily Berry, Stacie Miller and Keith E. Argenbright; John Peter Smith Health Network, Fort Worth’s Mark Koch; and San Diego Veterans Affairs Healthcare System’s Samir Gupta.

The research published in Scientific Reports did not explicitly test whether procrastination is in fact a roadblock, but the team designed their field test to follow findings from previous colorectal screening research “implicating procrastination as a key barrier to FIT completion.”

A control group was mailed the kit and given no deadline or financial incentive. Less than 5% of this group completed the test within three weeks. The completion rate among another group explicitly given a three-week goal was 7.2%.

An even shorter deadline proved to be a more effective nudge. Nearly 10% of people with a one-week deadline and no financial incentive followed through.

A small declining financial incentive coupled with a deadline did not prove to be any more effective than the short deadline with no incentive attached. The 9.1% completion rate of participants offered $10 if they completed the test within one week or $5 if they mailed it in within three weeks, was lower than the 9.7% completion rate for the group with a one-week deadline and no financial incentive.

It took a bigger financial nudge to compel more uptake among this lower-income pool of participants. More than 12% of people offered $20 if they took the test within one week or $10 if they took it within three weeks, completed the test — though the difference between this group and the one-week nonincentivized group was not statistically significantly different.

Keep the Deadlines Short

The researchers took a look at all study participants, regardless of whether they were in the control group or one of the nudge groups with different deadlines/incentives. Across the board among people who completed the test within three weeks, 75% took care of it in week one.

The results of this study suggest that future screening campaigns might embed a short deadline. Either to take an at-home test for colorectal cancer or schedule an in-person test for other preventative care.

It also adds to growing research showing more generally — not just in cancer screening — deadlines are an effective nudge to get past procrastination. If you struggle to make strides with your to-do list, consider adding short-term deliverable dates to see if that nudges you to take better care of you — and future you.