Using active choice to increase cancer screening


High-value cancer screening tests, including colonoscopy and mammography, help to identify cancer early. However, many eligible patients do not receive these tests. The electronic health record (EHR) has grown in adoption and could be leveraged to change clinician and patient behavior.


We evaluated an active choice intervention in the EHR that prompted physicians and their medical assistants to decide whether to order colonoscopy or mammography for patients visiting their internal medicine clinic.


The active choice intervention was associated with an increase in physician ordering of colonoscopy and mammography. The intervention was also associated with increased patient completion of colonoscopy but no change in patient completion of mammography. Based on these findings, the health system decided to expand the approach to other primary care clinics in the Penn Medicine network.

Upon expansion, we refined the active choice intervention to only deliver to medical assistants, who then templated orders for physicians to review and sign. Compared to control practices, we saw a significant increase in clinician ordering of colonoscopy and mammography at expansion sites, but no significant change in patient completion of either screening during a 1-year follow-up.


Leonard Davis Institute of Health Economics 

Related Videos

Why do cancer screening rates decline as the day progresses?

Mitesh Patel joins JAMA Network editors to discuss a quality improvement study evaluating the association of primary care clinic appointment time with clinician ordering and patient completion of breast and colorectal cancer screening. Read the article.