Inclusion Criteria:

- Patients aged 52-75 who had one visit to a primary care physician in a community
health center in each of the 2 previous years and who have not received colorectal
cancer screening based on HEDIS criteria.

Exclusion Criteria:

- Current cancer diagnosis, undergoing treatment (or treatment completed within the
past year)

- Severe cardiac disease (high-risk CAD,9 valvular disease, NYHA Class III or IV CHF,
EF < 35%)

- Severe COPD (FEV1< 1liter or on home oxygen)

- CVA with severe functional impairment (aphasia or hemiparesis)

- MS with severe functional impairment

- Renal failure with CrCl< 30 or on dialysis

- Gastrointestinal symptoms (pain, bleeding, etc) within the past 6 months

- Chronic active liver disease or cirrhosis, with albumin < 3 or elevated INR

- Advanced HIV disease (CD4 count <200)

- Severe lupus (with cerebritis or renal failure as defined above)

- Severe complications of diabetes (blindness, amputations other than toes)

- Advanced Dementia

- Psychosis

- Paranoia

- Active substance abuse

- Schizophrenia

- Psychiatric hospitalization within the past year