Choice Architecture and Colorectal Cancer Screening Outreach

This pilot study is a 3-arm randomized control trial assessing the effectiveness of
sequential or active choice in CRC screening outreach vs. colonoscopy outreach only. The
investigators will randomize participants to one of three study arms:

Arm 1: Direct schedule colonoscopy (Control) Arm 2: Direct schedule colonoscopy followed by
mailed FIT (Sequential Choice) Arm 3: Choice of direct schedule colonoscopy or mailed FIT
(Active Choice).

Inclusion Criteria:

- Between 50 and 74 years old

- Has a primary care provider who is a University City or Valley Forge Family Medicine
provider

- Has had at least 2 office visits at either practice

- Is due for colorectal cancer screening

- Is asymptomatic for CRC

- Subject's zip code is within the Philadelphia-Wilmington-Camden Metropolitan
Statistical Area

Exclusion Criteria:

- Has had prior colonoscopy within 10 years, sigmoidoscopy within 5 years, or FOBT/FIT
within twelve months of chart review (we will exclude patients who self-report any of
the above procedures)

- Has a history of CRC or colonic polyps

- Has a history of GI cancer

- Has a history of confirmed Inflammatory Bowel Disease (IBD)

- has a history of colitis other than Crohns disease or ulcerative colitis)

- Has a first degree relative that has been diagnosed with CRC

- Has had a colectomy

- Has been diagnosed with Familial Adenomatous Polyposis (FAP)

- Has been diagnosed with Lynch Syndrome (i.e. HNPCC)

- Has iron-deficiency anemia

- Has a history of lower GI bleeding

- Has metastatic (Stage IV) blood or solid tumor cancer

- Has end stage renal disease

- Has cirrhosis

- Has heart failure

- Has dementia

- Has any other condition that, in the opinion of the investigator, excludes the patient
from participating in this study