A Randomized Controlled Trial Testing Provision of Fecal and Blood Test Options on Participation for Colorectal Cancer Screening.

Suboptimal participation is commonly observed in colorectal cancer screening programs utilizing fecal tests. This randomized controlled trial tested whether the offer of a blood test as either a "rescue" strategy for fecal test nonparticipants or an upfront choice, could improve participation. A total of 1,800 people (50-74 years) were randomized to control, rescue, or choice groups (n = 600/group). All were mailed a fecal immunochemical test (FIT, OC-Sensor, Eiken Chemical Company) and a survey assessing awareness of the screening tests. The rescue group was offered a blood test 12 weeks after FIT nonparticipation. The choice group was given the opportunity to choose to do a blood test (Colvera, Clinical Genomics) instead of FIT at baseline. Participation with any test after 24 weeks was not significantly different between groups (control, 37.8%; rescue, 36.9%; choice, 33.8%; P > 0.05). When the rescue strategy was offered after 12 weeks, an additional 6.5% participated with the blood test, which was greater than the blood test participation when offered as an upfront choice (1.5%; P < 0.001). Awareness of the tests was greater for FIT than for blood (96.2% vs. 23.1%; P < 0.0001). In a population familiar with FIT screening, provision of a blood test either as a rescue of FIT nonparticipants or as an upfront choice did not increase overall participation. This might reflect a lack of awareness of the blood test for screening compared with FIT.

Free cholesterol testing as a motivation device in blood donations: evidence from field experiments.

BACKGROUND: Health tests are often seen as promising donor incentives to improve the supply of blood. However, systematic behavioral evidence on donor recruitment is scarce. STUDY DESIGN AND METHODS: To study the effectiveness of a free cholesterol test in attracting new donors and motivating previous donors, two field experiments were conducted. In Study 1, 2825 nondonors were randomly assigned to one of three treatments: a solicitation letter, a solicitation letter plus an appeal, or a solicitation letter plus an appeal and the offer of a free cholesterol test. In Study 2, 8269 previous donors were randomly assigned to one of three treatments: a standard invitation, an invitation plus an appeal, or an invitation plus an appeal and a cholesterol test. Marginal effects from probit estimations were calculated to study the effects of the treatments on donors' response. RESULTS: In Study 1, only 0.6 percent reacted to the solicitation letter. There were no significant differences in the response rates between the three treatments. In Study 2, 45.3 percent of the invited previous donors came to donate. The appeal (marginal effect, -0.5%; standard error [SE], 1.9%) and offering a cholesterol test (marginal effect, 1.6%; SE, 1.8%) did not significantly increase the probability of a donation relative to the standard invitation. The treatment effects for the cholesterol test did not systematically differ between frequent and infrequent donors and female and male donors. There is some evidence that young donors responded relatively most positive to the cholesterol test (marginal effect, 4.4%; SE, 2.2%). CONCLUSIONS: Contrary to conclusions from survey studies, free cholesterol testing did not significantly increase donations from nondonors and previous donors during a 3-month campaign. The two studies show that field experiments are an important method to evaluate donation incentives, because measuring donors' intentions alone can lead to significantly different conclusions.

Family and physician influence on asthma research participation decisions for adolescents: the effects of adolescent gender and research risk.

OBJECTIVE: There is considerable ethical and legal ambiguity surrounding the role of adolescents in the decision-making process for research participation. Depending on the nature of the study and the regulations involved, adolescents may have independent responsibility for providing informed consent, they may be asked to provide their assent, or they may be completely excluded from the decision-making process. This study examined parent and adolescent perceptions of decision-making authority and sources of influence on adolescent research participation decisions, and examined whether perceptions of influence differed based on adolescent gender and level of research risk. STUDY DESIGN: Adolescents (n = 36) with asthma and their parents reviewed 9 pediatric research protocols, decided whether they would choose to participate, rated the extent they would be responsible for the actual decision, and indicated the ability of family and physician to influence their decisions. Multivariate analyses of variance were used to evaluate differences in perceptions of decision-making authority and sources of influence on the decisions. RESULTS: Adolescents were less willing to cede decision making authority to parents than parents anticipated. Parents and adolescents acknowledged a greater openness to influence from physicians than from family for above minimal risk studies. Parents were more willing to consider opinions from male adolescents. CONCLUSIONS: Adolescents desire responsibility for research participation decisions, though parents may not share these views. Physicians' views on research participation are important to families, especially for above minimal risk studies. Parents may grant more decision-making autonomy to adolescent males than to females. Researchers, physicians, and institutions play a key role in facilitating the ethical enrollment of adolescents into biomedical research. Educational, policy, and oversight processes that support both adolescent autonomy and parental responsibility for research participation decision-making in biomedical research are discussed.