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Enhancing Organ Donor Registration Rates through Strengthening ServiceOntario Customer Representatives’ Motivations

Last registered on May 24, 2017

Pre-Trial

Trial Information

General Information

Title
Enhancing Organ Donor Registration Rates through Strengthening ServiceOntario Customer Representatives’ Motivations: Observational Studies and Field Interventions
RCT ID
AEARCTR-0001974
Initial registration date
May 24, 2017

Initial registration date is when the trial was registered.

It corresponds to when the registration was submitted to the Registry to be reviewed for publication.

First published
May 24, 2017, 4:21 PM EDT

First published corresponds to when the trial was first made public on the Registry after being reviewed.

Locations

Region

Primary Investigator

Affiliation
University of Toronto

Other Primary Investigator(s)

PI Affiliation
University of Toronto
PI Affiliation
University of Toronto
PI Affiliation
University of Toronto
PI Affiliation
Johns Hopkins Univeraity

Additional Trial Information

Status
In development
Start date
2017-06-12
End date
2018-06-01
Secondary IDs
Abstract
In virtually every country, the need for organs for transplants far exceeds supply, leaving many patients to spend years waiting and even die before receiving a transplant. In the U.S. in 2009, for instance, where there are about 26 donors per million people, among candidates newly wait-listed for either a first or repeat kidney transplant the median wait time was 3.6 years (about one year for a liver transplant), and only slightly over 60% of individuals waitlisted ever received an organ. Approximately twenty individuals die each day because they cannot find a matching donor. In addition to the implications for transplant candidates, a kidney transplant, for example, also saves at least $200,000 over the life of the individual relative to on-going dialysis treatment.

Donation rates are even lower in Canada, with about 15 deceased donors per million people. In 2013, for example, there were 1,419 kidneys transplanted — 588 of which from living donors — but that left more than 3,000 Canadians on the waiting list for a new organ. Almost 42,000 Canadians were living with failing kidneys, creating an unprecedented demand for dialysis and transplants. During 2010, 229 patients died while waiting for organs. The end of that year saw 501 patients waiting for a liver, 135 for a heart, 310 for a lung and 98 for a pancreas.

There are many opportunities for individuals to express their intention to become an organ donor. In particular, when visiting public offices such as ServiceOntario for a variety of services (e.g., obtaining or renewing a driver’s license or health card), individuals have the opportunity to consent to be added to the organ donor registry when asked by a customer service representative (CSR). Similar procedures occur in the United States at the offices of the Department of Motor Vehicles (DMV). Yet, registration rates, although increased over the past few years, remain surprisingly low in Canada, at about 20-30%. These low donor registration rates are especially frustrating and surprising in light of the fact that an overwhelming majority of Canadians support organ donation – in Ontario in particular, 85% of citizens are in favour of organ donation.

With an aging population, advances in medical knowledge and technologies that make transplants an increasingly applicable option for many patients, and a growing ethnic heterogeneity that requires a more diverse composition of the organ supply, the imbalance between demand and supply is bound to increase, thus exacerbating individual, social and economic costs that could be avoided if more people behaved consistently with their beliefs and donated their organs.

The objective of this research is to apply concepts and methods from social and behavioural science to understand how registration rates can be increased, thus providing a larger base of potential donors to address the organ supply shortage and improve health and living prospects of thousands of Canadians and their families.

Previously, ServiceOntario and the Trillium Gift of Life Network partnership with academics explored whether low registration rates may be due in part to the length and complexity of registration forms or the timing when those forms are handed out. Moreover, these partners also tested interventions leveraging emotional and perspective-taking appeals, and discovered that these minor changes to the organ donor registration forms can significantly increase the rate with which Ontarians sign-up as organ donors.

In this proposal, we take a new but complementary perspective, focused on the customer service representatives who help Ontarians register using the forms. We ask whether and how the performance of customer service representatives at ServiceOntario offices, who are instructed to ask each customer whether they would like to register their consent to become organ donors (a “prompted choice” approach), can be improved.

Our interventions will consist of providing information to each CSR about his or her organ donor registration rate, with and without a comparison with that of the rest of ServiceOntario CSRs' conversion rates, using historical data. The idea would be that learning that, for example, the majority of other CSRs more effectively register organ donations might encourage a CSR to be more consistent in asking customers about their willingness to register and thereby improve their personal effectiveness. The information provided will not affect any actual evaluation of the CSRs; their relative effectiveness in terms of “conversion rates” of customers into donors will not be used for any formal performance evaluation, promotion or salary determination. Also, CSRs’ relative effectiveness is disclosed only to them individually but not to their peers.

The proposed interventions are based on the hypothesis that simply providing information about relative effectiveness, even when it has no impact on economic outcomes for an individual (i.e., compensation or promotion), will still have an impact by appealing to other, non-monetary forms of motivation (e.g., one’s self-image). If effective, this and similar interventions may represent simple, cost-effective ways to motivate CSRs, and are likely to be applicable to other contexts where relative effectiveness and activities with a pro-social component are present.

Scholars have performed similar behavioral investigations to study, for example, whether the (over)prescribing behavior or physicians is affected by providing aggregate statistics of the behavior of peers (http://jamanetwork.com/journals/jama/fullarticle/2488307); and whether information about one student's as well as other students' absence rate helps reducing excess absenteeism at school (http://scholar.harvard.edu/files/todd_rogers/files/influential_third_parties.pdf).

External Link(s)

Registration Citation

Citation
Lacetera, Nicola et al. 2017. "Enhancing Organ Donor Registration Rates through Strengthening ServiceOntario Customer Representatives’ Motivations: Observational Studies and Field Interventions." AEA RCT Registry. May 24. https://doi.org/10.1257/rct.1974
Former Citation
Lacetera, Nicola et al. 2017. "Enhancing Organ Donor Registration Rates through Strengthening ServiceOntario Customer Representatives’ Motivations: Observational Studies and Field Interventions." AEA RCT Registry. May 24. https://www.socialscienceregistry.org/trials/1974/history/17968
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Experimental Details

Interventions

Intervention(s)
Details of the interventions are reported in the description of the experimental design below.
Intervention Start Date
2017-06-12
Intervention End Date
2017-12-31

Primary Outcomes

Primary Outcomes (end points)
The main outcome of interest will be the in individual organ donor registration rates before and after the intervention. The registration rates of each CSRs will be the ratio: number of new individuals added to the organ donor registry while served by the CSR / total number of clients served for transactions for which a CSRs is expected to ask about the desire to join the registry. We will calculate these values, before and after the intervention, for periods up to six months before and six months after.

We will also keep track of the overall intensity/amount of activity of each CSR other than signing up new organ donors.
Primary Outcomes (explanation)

Secondary Outcomes

Secondary Outcomes (end points)
Secondary Outcomes (explanation)

Experimental Design

Experimental Design
The intervention will involve 79 sites directly managed by Service Ontario (it excludes private Service Ontario centers)
We will randomly assign each site to one of three conditions. Each site will be in the same condition in the two times in which it will be treated: Early June 2017, and early November 2017.

Group 1 – CSRs in Group 1 offices will receive general information about organ donation, as well as some tips for asking customers to sign up.

Group 2 – CSRs in Group 2 offices will receive general information about organ donation, some tips for asking customers to sign up, as well as quantitative information about their individual registration rates, in numeric as well as graphical form (bar chart). The registration rates that we will report is the average over six months (November 2016-April 2017 for the first round, and May 2017-October 2017 for the second round).

Group 3 – CSRs in Group 3 offices will receive general information about organ donation, some for asking customers to sign up, as well as quantitative information about their individual registration rates, and the average and 80th percentile registration rates in the region to which the center belongs (there are four regions: Central, Western, Eastern and Northern Ontario). This information, again, will be both in numeric and graphical form (bar chart).
The registration that we will report is the average over six months (November 2016-April 2017 for the first round, and May 2017-October 2017 for the second round).

In group 2 and 3, the communication will include a note specifying that the registration rate information is exclusively for informational purposes and will not affect any formal evaluation.

CSRs who have worked in more than one office in the months preceding the interventions will be assigned the condition corresponding to the office where they worked most days over the six-month period of interest before the intervention. Their registration rates, however, will be calculated including their interactions, and organ donor registrations, in all of the offices where they worked. A note in the communication that all CSRs will receive (if they are in Groups 2 or 3) will clarify this.

The communications just described will occur via email. An email from the Assistant Deputy Minister-Customer Care at service Ontario will inform about further communication to follow about organ donation registrations.

In order to protect the privacy of the CSRs and to not exert undue influence, we will not inform the CSRs of the intervention under way. The researchers will not have access to the identity of the CSRs or other identifying information. We will elaborate a procedure such that it will be possible to assign CSRs to different treatments using numerical IDs, and to use these IDs to follow CSRs over time.
Experimental Design Details
Randomization Method
Randomization will come from a computer-based random number generator.
Randomization Unit
Randomization will be at the centre level -- all CSRs in one centre will receive the same treatment condition.
Was the treatment clustered?
Yes

Experiment Characteristics

Sample size: planned number of clusters
79 centres, approximately 700 CSRs.
Sample size: planned number of observations
At the moment we do not have the exact number of CSRs at the 79 locations. Information based on the beginning of 2016 indicates a total of approximately 700 CSRs. We will have access to information on their transactions, and therefore new organ donor registration. Information on donor registration will be at the center-CSR-day level, and we will then aggregate to compute averages.
Sample size (or number of clusters) by treatment arms
Each treatment arm will is expected to have an equal number of observations. because the number of centers is not divisible by 3, there will be a slight imbalance. Within each region, we will randomly assign M/3 centers to each conditions, where M is the greatest number that is less then or N, i.e. the number of centers in a region. Each of the remaining N-M sites, if any (one or two) will be randomly assigned, with equal probabilities, to one of the three conditions.
Minimum detectable effect size for main outcomes (accounting for sample design and clustering)
IRB

Institutional Review Boards (IRBs)

IRB Name
Homewood Institutional Review Board --Johns Hopkins University
IRB Approval Date
2017-05-01
IRB Approval Number
HIRB00005769
IRB Name
University of Toronto Social Sciences, Humanities, and Education Research Ethics Board
IRB Approval Date
2016-03-21
IRB Approval Number
32650

Post-Trial

Post Trial Information

Study Withdrawal

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Intervention

Is the intervention completed?
No
Data Collection Complete
Data Publication

Data Publication

Is public data available?
No

Program Files

Program Files
Reports, Papers & Other Materials

Relevant Paper(s)

Reports & Other Materials