Need: Colorectal cancer (CRC) screening in average risk adults ages 50-75, and perhaps 45-49, can reduce the incidence and mortality from CRC, but implementation and uptake of screening has been sub-optimal, particularly for vulnerable patients, including those living in rural areas, the uninsured, and those with low English language proficiency. Mailing fecal immunochemical tests (FIT) can increase screening rates over reliance only on traditional, practice-based approaches. Similarly, patient navigation offers an opportunity to help patients overcome barriers to completion of screening tests and follow-up colonoscopies, particularly for vulnerable patients with high social needs and limite...

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Need: Colorectal cancer (CRC) screening in average risk adults ages 50-75, and perhaps 45-49, can reduce the incidence and mortality from CRC, but implementation and uptake of screening has been sub-optimal, particularly for vulnerable patients, including those living in rural areas, the uninsured, and those with low English language proficiency. Mailing fecal immunochemical tests (FIT) can increase screening rates over reliance only on traditional, practice-based approaches. Similarly, patient navigation offers an opportunity to help patients overcome barriers to completion of screening tests and follow-up colonoscopies, particularly for vulnerable patients with high social needs and limited social support. We have shown, through our previous CPRIT-funded work, that implementing mailed FIT plus patient navigation can increase screening in underserved urban patients in Travis County; similar programs have been successful in Dallas, Fort Worth, and El Paso. However, much of the state remains underserved with respect to colon cancer screening for uninsured patients, especially those in rural areas. Expanding access to cost-effective mailed FIT and subsequent patient navigation in partnership with community health centers can help increase screening and reduce CRC incidence and mortality. Overall project strategy: Through the Dissemination of CPRIT-Funded Cancer Control Interventions award process, we seek to develop an evidence-informed blueprint, implementation guide, and consultation service for expanding mailed FIT programs to underserved areas of Texas, in cooperation with other Texas institutions and a statewide organization of Federally Qualified Health Centers. Our team has extensive experience in developing and implementing interventions to improve CRC screening in vulnerable populations, including mailed FIT. In addition, we bring expertise in the use of geographic information systems (GIS) to identify areas of the greatest need, experience in developing cost-effective CRC screening programs, and experience in forming coalitions of diverse stakeholders around a common health goal, in this case reducing the burden of colon cancer. Specific goals: We propose to form an expert team to 1) identify areas of Texas in high need of screening improvement (low screening rates, high incidence and mortality) not currently served by existing programs; 2) reach out to local community health centers and gastroenterologists in these areas to identify local support for development of mailed screening programs through the use of active dissemination strategies, including technical assistance and site-specific consultation; 3) and understand the cost and potential benefits of implementing mailed FIT in communities at highest need, based on different levels of investment in program development and expansion. Significance and Impact: Our hope is to identify how underserved Texas communities could be efficiently and effectively served through CPRIT-funded mailed FIT programs. By taking advantage of the low-cost and scalability of mailed FIT coupled with local navigation to colonoscopy as a means of reaching underserved and rural communities, we can increase CRC screening rates, reduce health disparities, and serve as a model for other states.

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