Study of Colorectal Cancer Screening Options

The investigators propose to evaluate Guardant Health's commercially available colorectal cancer screening assay(Guardant SHIELD) in individuals who are not up to date with CRC screening.

Primary Objective (or Aim) Assess colorectal cancer screening completion among patients who are non-adherent after receiving stool test outreach, who have an upcoming clinical appointment, and who are offered a commercially available colorectal cancer blood test versus usual care (i.e. reminder to complete stool testing during their clinical appointment).

Secondary Objectives (or Aim) Assess patients' and providers' perceived confidence in the test (based on available test performance characteristics) and willingness to obtain/offer the test on an on-going basis, based on qualitative interviews; assess preliminary rates of follow-up colonoscopy completion (after an initial abnormal test result) among participants allocated to the blood test vs. usual care condition.

Inclusion criteria

• Age 45-75
• Received a FIT test in the last 3-9 months yet did not return their FIT
• Upcoming appointment or willing to reschedule an appointment at KPNW within 2 - 6 weeks
• Able and willing to provide informed consent if in the intervention arm

Exclusion criteria

• On KPNW's do not contact list
• Having a legal authorized representative
• Non-English speakers