NEED: Low-income women residing in rural and medically underserved areas (MUAs) of Texas (TX) suffer from significantly higher incidence and mortality rates associated with some cancers (Risser, 2012; Ojinnaka, 2016). Barriers to cancer screenings among rural TX women may include driving distance, lack of transportation, fear of finding cancer, language barriers, or even medical mistrust. Family medicine physicians, nurses and nurse practitioners (NPs), and community health workers (CHWs) working in rural underserved areas play an important role in ensuring provision of evidence-based screenings and education, provided in a safe and culturally sensitive environment.

TX ranks 46th among all...

Read More

NEED: Low-income women residing in rural and medically underserved areas (MUAs) of Texas (TX) suffer from significantly higher incidence and mortality rates associated with some cancers (Risser, 2012; Ojinnaka, 2016). Barriers to cancer screenings among rural TX women may include driving distance, lack of transportation, fear of finding cancer, language barriers, or even medical mistrust. Family medicine physicians, nurses and nurse practitioners (NPs), and community health workers (CHWs) working in rural underserved areas play an important role in ensuring provision of evidence-based screenings and education, provided in a safe and culturally sensitive environment.

TX ranks 46th among all states for breast cancer screening and 43rd for pap test screening (NCI SEER, 2020). TX also has the highest age-adjusted incidence rate of hepatocellular (liver) cancer (HCC) (ACS, n.d.). Efforts to prevent HCC include risk factor assessment and education, and testing for the Hepatitis C virus thought to be responsible for 50% of all HCCs (CDC, 2019; Knight, 2018). For skin cancer, another lifestyle-related cancer, higher rates for melanoma have been reported in rural versus metropolitan areas (Blake, Moss, Gaysynsky et al. 2017).

Initially funded by CPRIT in 2013, TX Cancer Screening, Training, Education and Prevention (C-STEP) provided 3,503 breast and cervical cancer clinical services, reached 276,000 persons with prevention education, and directly served almost 12,000 women with education or navigation. According to CPRIT portfolio maps, no CPRIT-funded prevention programs for liver cancer screening and early detection exist in 14 of the current 17 C-STEP counties (CPRIT, 2019).

OVERALL PROJECT STRATEGY: The proposed expansion plan (PP200070) will allow TX A&M Family Medicine Residency, College of Nursing, and School of Public Health to provide 4,235 evidence-based screening and diagnostic services to 1,800 unique women, and serve 12,000 people directly with education, patient care, or navigation services ‐ focusing on low-income, rural and/or medically underserved women.

In response to CPRIT RFA P-20.2-EPS, TX C-STEP will expand its women's health program to include direct services for not only breast and cervical cancer, but also for colorectal, liver and skin cancer. C-STEP will expand its geographic reach - to include rural northern Harris County, rural coastal plains counties (DeWitt, Karnes, Lavaca), and Goliad County.

Activities to support our rural expansion strategy include: (1) State-certified CHWs to provide prevention education, determine financial qualification, obtain self-referrals, conduct knowledge assessments, patient reminders, and reduce barriers to screening. (2) Rural community partners, in our existing network of 467 (e.g., churches, agencies, civic leaders), to support outreach and education activities at events in target counties. (3) C-STEP's expanding clinical network, consisting of 200 providers, to refer women for services. (4) Rural mobile mammogram days, using The Rose for radiology services, to reduce barriers in our 21-county service area. (5) Direct services expansion, to add assessment for HCC risk factors, Hepatitis C tests, skin cancer screening, FIT tests, ultrasounds and biopsies. (6) NP-led well-woman days, with TX A&M advanced practice registered nurse faculty and student trainees, to provide cancer screenings and navigation in rural clinics/host sites, including those managed by Falls Community Hospital & Clinic, Tomagwa Healthcare Ministries, and Cuero Regional Hospital. SPECIFIC GOALS: We will provide education, navigation, and comprehensive cancer screening and diagnostic services for low-income rural and medically underserved women in 21 TX counties, while providing expanded cancer prevention training to family physician residents, nursing and NP students, and CHWs. Specific goals: 1) Increase (by up to 4,235) the number of breast, cervical, colorectal, liver, and skin cancer screenings and follow-up diagnostics, provided to 1,800 low-income, underserved and rural women in TX; 2) Reach 180,000 people indirectly with cancer prevention education specific to breast, cervical, colorectal, liver, and/or skin cancer, and provide 9,105 direct education, navigation and follow-up services; 3) Increase, by >150, the pool of BSN nursing students, family medicine resident physicians, and family NP students who receive direct training in cancer screening and related diagnostics. SIGNIFICANCE & IMPACT: The volume of services associated with Texas A&M's interdisciplinary screening and prevention program will contribute to early detection of cancers and reduction of cancer mortality in TX, and serve as a model for training the next generation of rural health professionals in evidence-based cancer prevention and care.

Read Less