08:24 AM

iThriv Pilot Award Funds an Investigation into Patient-Reported ‘Sludge’

sludge book

John Epling, MD, MSED- Vice Chair for Research and Population Health, Family & Community Medicine and Michelle Rockwell, PhD, RD- Senior Research Associate, Family & Community Medicine

Although screening plays an important role in the prevention of multiple forms of cancer, current screening rates remain well below desired levels, particularly among some demographic groups. Most efforts to improve cancer screening rates have focused on patient education and clinician adherence to screening recommendations. The National Cancer Institute, President’s Cancer Moonshot Initiative, and several other national organizations and initiatives encourage the study of health systems factors that influence cancer screening. Our research team is interested in ‘sludge’ as one such health system factor.

Popularized in a 2022 book by Cass Sunstein, JD (Harvard Law), sludge is a behavioral economics term that describes frictions or administrative burdens that keep people from achieving what they want or need. Examples of sludge may include unnecessary paperwork, long wait times, and redundant or confusing administrative processes. We hypothesize that sludge impacts patients, clinicians, and other key players in the cancer screening process and that identifying and reducing sludge is a novel approach to improving cancer screening rates. There is evidence that sludge disproportionately impacts disadvantaged populations, so reducing sludge may also improve equity of cancer screening. Our team pilot tested a sludge audit method to identify and quantify sludge in a health system’s colorectal cancer screening process (American Journal of Managed Care, June 2023).

An important limitation of our sludge audit method is that it did not incorporate patients’ perspectives and direct experiences. Thus, we applied for a 2022-2023 iThriv pilot grant to fund a study focused on patients’ experience with cancer screening and were fortunate to receive this $50,000 award along with collaborators Paul Yeaton, MD (Carilion), Sarah Parker, PhD (Virginia Tech), Jeff Stein, PhD (Virginia Tech), and Li Li, MD, PhD (UVA). The Integrated Translational Health Research Institute of Virginia (iThriv) is a National Institutes of Health (NIH)-funded Clinical and Translational Science Award (CTSA) Program Hub collaboration between Carilion Clinic, Virginia Tech, University of Virginia, and the Inova Health System. Our project engages patients through community engagement studios, interviews, and a survey. We have learned a tremendous amount from our patients so far and look forward to sharing results.

The 2023-24 iThriv pilot grant cycle will focus specifically on translational research studies. So many of our Carilion Clinic research colleagues are uniquely well-positioned to submit a meaningful translational project application. We would be happy to share our experiences, resources, and lessons learned during the iThriv pilot grant-writing process and project execution with any Carilion Clinic colleagues. Of course, one of the goals will be reducing sludge in the process!

Link to ‘Sludge’ by Cass Sunstein, JD