Key Points Question Does the offering of choice between colonoscopy and fecal immunochemical testing (FIT) change participation in screening outreach? Findings In this 3-arm pragmatic randomized clinical trial of 438 patients, there was no statistically significant increase in screening when offering the choice of FIT compared with colonoscopy only, but fewer patients selected colonoscopy in the choice arms. Meaning Offering the choice of FIT in a colonoscopy outreach program did not substantially increase screening participation, but the framing of choice altered patient decision making.

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