Active Choice to Improve Colorectal Cancer Screening Outreach

Active Choice to Improve Colorectal Cancer Screening Outreach

Project status

Pilot/study with results


Chyke Doubeni, MD, MPH 

Vikranth Induru, MD 

David Santos 

Timothy McAuliffe 

Charles Orellana, MD 

Kevin Volpp, MD, PhD 

Innovation leads


Penn Roybal Center 

National Institute on Aging


Colorectal cancer (CRC) is the second leading cause of cancer-related deaths among men and women in the United States. It is recommended that individuals begin regular screenings for CRC at the age of 45. Screening can prevent cancer by discovering precancerous polyps that can be removed before they turn into cancer. It can also find CRC early when treatment often leads to a cure.  

Patients have several options when it comes to completing screening. The most common are colonoscopy and FIT (fecal immunochemical test).  

Unfortunately, millions of people in the United States are not getting screened for CRC. 


We conducted a clinical trial to explore the effect of active choice on CRC screening rates. We sent patients mailed outreach offering CRC screenings in one of three ways: 1) colonoscopy only, 2) colonoscopy at first and – if they did not schedule or complete a colonoscopy – then, FIT (sequential), or 3) active choice of colonoscopy or FIT (simultaneous). 


We observed no significant difference in CRC screening among the three groups. However, the rate of completed screenings via colonoscopy was much lower in the choice arms – 52 percent for sequential and 38 percent for active – than in the colonoscopy-only arm. These results indicate that framing choices affects patients’ health care decisions.