The C-SPAN Coalition: Colorectal Cancer Screening and Patient Navigation

Participants will be mailed an invitation to complete CRC screening along with a fecal immunochemical test (FIT) kit, containing a 1-sample "Polymedco Over the Counter (OC) Sensor FIT", simplified English/Spanish instructions on performing the test, educational information about colorectal cancer screening and a return mailer with prepaid postage. Processes that will be used to promote screening completion include automated and "live" phone call reminders to encourage completion of FIT testing. Participants will be randomly assigned to 1 of 5 interventions across 3 conditions, described below: 1. Condition 1 (Standard Intervention): * Branch I: Participants assigned to the control condition will receive a FIT kit and the standard invitation letter to participate in free screening. 2. Condition 2 (Time Guideline): * Branch II: Participants will receive a FIT kit and invitation letter to participate in free screening with a 1-week time restriction. * Branch III: Participants will receive a FIT kit and invitation letter to participate in free screening with a 3-week time restriction. 3. Condition 3 (Time Guideline + Incentive): * Branch IV: Participants will receive a FIT kit and invitation letter to participate in free screening requesting they return the kit within 1-week for a "higher" monetary incentive or within 3 weeks for a "lower" (half of the higher) monetary incentive. * Branch V: Participants will receive a FIT kit and invitation letter to participate in free screening requesting they return the kit within 1-week for a "higher" (same as lower in Branch IV) monetary incentive or within 3 weeks for a "lower" (half of the higher) monetary incentive. Participants with a normal test result will receive a personal letter confirming this with invitations to complete a repeat screening in subsequent year(s). Participants receiving an abnormal FIT result will be navigated to complete a diagnostic colonoscopy. Participants continuing in the screening program in subsequent years will receive letters emphasizing the importance of repeat screening to prevent adverse CRC outcomes.

Sex

All

Minimum age

50 Years

Maximum age

74 Years

Inclusion Criteria:

* Uninsured or Underinsured
* English or Spanish speaking
* No history of colon cancer or colon resection
* No history of inflammatory bowel disease
* Colonoscopy not completed in the last 10 years
* Sigmoidoscopy not completed in the last 5 years
* Fecal Occult Blood Test (FOBT) or fecal immunochemical test (FIT) not completed in the last year
* Complete contact information on file
* Not incarcerated or homeless

Exclusion Criteria:

* Under 50 or over 74 years of age
* Insured but not underinsured
* Other than English or Spanish speaking
* History of colon cancer or colon resection
* History of inflammatory bowel disease
* Colonoscopy completed within the last 10 years
* Sigmoidoscopy completed within the last 5 years
* FOBT or FIT screening completed within the last year
* Incomplete contact information (i.e., no address or phone number on file)
* Incarcerated or homeless

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