Need: Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Texas. In 2019, CRC was the third leading cancer diagnosis and the third leading cause of cancer-related death for male and female Texans. 12,444 Texans were estimated to be diagnosed with CRC in 2022, with 4,447 Texans being estimated to die from the disease. CRC disproportionately affects multiple population subgroups, including racial/ethnic minorities, individuals with limited access to healthcare, and individuals with low socioeconomic status (SES). Similarly, CRC incidence and mortality rates in Texas have been the highest among racial/ethnic minorities and individuals living in non-metropolitan areas. Moreo...
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Need: Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in Texas. In 2019, CRC was the third leading cancer diagnosis and the third leading cause of cancer-related death for male and female Texans. 12,444 Texans were estimated to be diagnosed with CRC in 2022, with 4,447 Texans being estimated to die from the disease. CRC disproportionately affects multiple population subgroups, including racial/ethnic minorities, individuals with limited access to healthcare, and individuals with low socioeconomic status (SES). Similarly, CRC incidence and mortality rates in Texas have been the highest among racial/ethnic minorities and individuals living in non-metropolitan areas. Moreover, screening rates in Texas have been the lowest among low-income and uninsured individuals. It is widely known that regular screening for CRC is the most effective way to mitigate risks of the disease, with the United States Preventive Services Task Force (USPSTF) recommending regular screening for adults aged 45-75 years old. However, only 66.8% of 50 – 75-year-old Texans reported being up-to-date with CRC screening in 2020. Moreover, Texas has very low screening adherence compared to the rest of the US, ranking 49th out of all US States, including Puerto Rico and Washington DC. Our project aims to implement a sustainable, large-scale CRC screening program for rural and medically underserved populations across our 67-county wide service area, reducing existing disparities and improving CRC-related health outcomes in these communities. Overall Project Strategy: Maintenance expansion of the CSPAN program will continue to provide a more inclusive approach to CRC prevention in North Texas, ensuring uninsured, low-income individuals will have access to comprehensive CRC screening services. The program will utilize a multicomponent intervention to increase CRC screening rates within the service area, combining navigation services and health promotion with mailed Fecal Immunochemical Test (FIT) outreach. Coalition partners affiliated with community health clinics and Federally Qualified Health Centers (FQHCs) will actively refer age-eligible adults who are not adherent to USPSTF screening recommendations for invitation into the program. Program participation will also be extended to individuals who are not engaged with the healthcare system via self-enrollment in the program, in response to community outreach or education events or through contacting our dedicated 800 number. FIT results, clinical services, and navigation to follow-up care will follow FIT completion, as well as reminder calls for participants who have not completed their FIT. Further, the CSPAN program will utilize validated survey instruments to assess barriers to CRC screening and colonoscopy completion within the patient population, facilitating the development of targeted interventions that can be utilized to improve screening and colonoscopy completion rates. Specific Goals: This program aims to optimize the delivery of CRC screening services to rural and medically underserved populations in the North Texas area, leveraging existing central processes within our virtual integrated system. Knowing that it is imperative to understand obstacles that may impede screening completion, our CSPAN program also aims to assess the social determinants of health (SDoH), attitudes, and barriers towards the completion of screening and diagnostic procedures within the patient population. The program will target 660,982 medically underserved, age-eligible adults, residing in the predominantly rural 67-county service area. Approximately 40,000 eligible patients will be invited to participate in CRC screening over five years, resulting in an estimated 15,000 completed FITs, 669 diagnostic colonoscopies, 395 individuals diagnosed with precancerous polyps, and 20 individuals being diagnosed with colorectal cancer. Significance and Impact: Ensuring the low-income, uninsured, and medically under resourced populations across our service area have access to comprehensive cancer screening services is necessary to reduce CRC incidence and mortality rates in North Texas. Our CSPAN program utilizes community education and outreach to invite individuals for screening, established community partnerships to provide clinical services across a broad geography, and centralized reimbursement to ensure successful linkage to care and access to treatment. The services offered span the cancer continuum of care, including public education and outreach, cancer prevention and early detection, and navigation to follow-up evaluation and affordable treatment. Delivering CRC screening services to these health-disparaged populations can prevent the development of CRC through the identification and removal of pre-cancerous polyps, promote the detection of CRC at early, easier to treat stages, and reduce the overall prevalence and burden of CRC in North Texas communities.
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