Early cancer screening – a matter of life and death

Using behavioural science to drive up telehealth cancer screening rates

"Only about 4 out of 10 colorectal cancers are found at an early stage"

The behavioural challenge - Encourage screening

Colorectal cancer is a leading cause of cancer death in the US. However, when colorectal cancer is found at an early stage before it has spread, the 5-year relative survival rate is about 90%. But only about 4 out of 10 colorectal cancers are found at this early stage. A primary reason for this is that about 1 in 3 people in the US who should get tested for colorectal cancer have never been screened. A range of testing approaches exist including those conducted at the doctors office, or non-invasive at home kits ordered online via telehealth that don’t require an office visit.

During the height of the COVID-19 pandemic there was a clear need to keep patients out of healthcare facilities where possible. As our client was keen to develop at-home testing kits the behavioural objective here was simple – what solutions can we offer that drive at-risk populations to order testing kits online via telehealth, and save HCP time and resource?

Our approach

We recommended an evidence-based approach for identifying what might be driving someone to test at home (perception of risk, family history, lack of insurance, covid concerns) and what could be preventing uptake of at- home testing (lack of IT skills, lack of computer, lack of awareness). Without this information it would be difficult for our client to diagnose barriers to online testing at a national level and develop strategies to address them.

As an example

A 20-minute online quantitative survey was conducted with a robust US consumer sample across a mix of pre-identified variables such as presence of cancer risk factors, digital competence and so on. We recommended our client develop survey questions structured around the EAST behaviour change framework to specifically measure how Easy, Attractive, Social, and Timely the desired behavior is. These insights could then be used by our client to overcome key barriers and help trigger the desired behavior among our different target audiences.

To understand how ‘Easy’ ordering online may be we collected information about digital habits, time spent on the internet, how frequently individuals make online purchases, whether they have used other telehealth tools, etc. as well as perceptions on administering the kit at home.

To assess how ‘Attractive’ requesting screening online was we developed scale questions to understand level of concern relating to online technical proficiency, online security and privacy concerns about sharing health information online, as well as beliefs about the need for cancer screening.

In terms of the ‘Social’ aspect of this behaviour, we asked questions relating to consumers’ relationship with their doctor, the extent to which they communicate health concerns and worries with friends or family and so on.

With regards to ‘Time’ we sought to better understand the triggers that may motivate an online request for screening (e.g. recent cancer diagnosis in family, reaching an age milestone, etc.) as well as perceptions around expected time to result online versus via a HCP.

Our solution

Two key behavioural groups were identified. Recommendations were made which aligned with the drivers and barriers to online testing of each group. The first group were very anti online screening. For this group, the focus of our recommendations was on reducing the significant perceived barriers to online screening (rather than enhancing benefits). The diagram on the right illustrates key recommendations.

The second group were easier to convert - there were few barriers relating to completing online screening beyond awareness of the option and assurances around the turnaround time of results (Timely).

We recommended testing various communications highlighting and promoting average turnaround time (e.g. 95% of tests returned in 2 weeks, comparison to in-person turnaround times) or adopting a similar approach to online shopping whereby you can track the ‘status’ of your test once ordered online i.e. in shipment, with lab, processed by lab, test returned etc. While this doesn’t directly shorten the turnaround time, it puts the consumer in control of the process and provides reassurance of progress.

Social: The lack of interaction with a real doctor. To overcome this, we should ensure help links are available to talk to a real person if stuck

Easy: The lack of clarity about how to navigate online to order test; further simplification of online look and feel required to minimise burden

Attractive: Greatest barriers existed around privacy of personal data which could be overcome by more prominently displaying the various steps used to protect private data in any new offering.

The outcomes

A number of the recommendations from the research have been implemented by the client as part of their development process. A subsequent repeat of the research is likely to be re-run in order to provide a measure of the change in attitudes as it relates to preferences for online testing as a result of these measures.