Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US and in Texas. Our target area consists of 70 West Texas counties located in Public Health Regions 1, 2, 8, 9 and 10 that have a combined population of 2,898,485.

We plan a phased approach: in Phase one we will provide services in 15 rural, frontier and US-Mexico border counties in the Big Bend region that have a combined population of 1,297,521 and cover 40,054 square miles (which is larger than 15 states of the US.) These counties have high rates of poverty, low educational attainment, low rates of healthcare coverage, have a significant number of Hispanic residents (ranging from 34.5%-82.8% in different co...

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Colorectal cancer (CRC) is the second leading cause of cancer deaths in the US and in Texas. Our target area consists of 70 West Texas counties located in Public Health Regions 1, 2, 8, 9 and 10 that have a combined population of 2,898,485.

We plan a phased approach: in Phase one we will provide services in 15 rural, frontier and US-Mexico border counties in the Big Bend region that have a combined population of 1,297,521 and cover 40,054 square miles (which is larger than 15 states of the US.) These counties have high rates of poverty, low educational attainment, low rates of healthcare coverage, have a significant number of Hispanic residents (ranging from 34.5%-82.8% in different counties) and are critically medically underserved, with several having no physicians.

Available data for this region indicates that between 2009 and 2013 there were 2,071 new cases of CRC and 697 CRC deaths, and that CRC incidence and mortality rates exceed the Texas average in the majority of these counties. CRC screening can reduce incidence and mortality, yet screening rates are significantly below the Texas and US averages of 63.5% and 69% in 13 of the 15 counties in this area (range 27.7% - 53.3%).

Our comprehensive needs assessment reveals the following critical barriers to CRC screening in this region: 1) lack of knowledge about the importance of CRC screening among the population; 2) lack of access to CRC screening services; 3) cultural barriers and myths about screening; 4) structural barriers to screening and diagnostic testing; 5) limited implementation of evidence-based strategies in medical settings; 6) suboptimal information sharing across patient referral pathways; and 7) lack of knowledge about patient barriers to screening among medical providers and staff.

The Southwest Coalition for Colorectal Cancer Screening (SuCCCeS) is a TTUHSC-El Paso led collaboration among public, private, non-profit, and for-profit health service providers: nine hospitals, and 26 clinics, the City Department of Public Health), the Paso del Norte Health Information Exchange, El Paso First Health Plans, the Texas DSHS region 9/10 family services program, Desert Mountain AHEC, the American Cancer Society and about 150 additional community partners (e.g. churches, community centers, foodbanks, El Paso Public Housing).

This program was designed to systematically address critical barriers to CRC screening among CPRIT priority populations of the uninsured, the underinsured, those residing in non-metropolitan, rural and frontier counties, the geographically isolated and cultural and minority populations. The program arose out of a one year group planning process that included a comprehensive assessment of community needs, barriers to screening in the medical setting, and the experiences of an established CPRIT-funded CRC screening program. This culminated in the production of a logic model that guided program development.

We will significantly expand services to a large number of counties that do not provide CPRIT supported CRC screening services. This program targets multiple levels of the socioecological model for health, and includes research-tested outreach, patient education, clinical service delivery, patient navigation and technical assistance for adoption and implementation of evidence based interventions into traditional (clinics) and non-traditional screening settings (e.g. ERs and urgent care centers).

The goals of the SuCCCeS program are: 1) Expand access to CRC screening services for populations in West Texas; 2) Disseminate research-tested, theory-based, culturally tailored bilingual CRC education through multiple methods; 3) Facilitate the adoption and implementation of evidence-based screening strategies into clinical settings; 4) Increase screening and diagnostic test uptake and treatment completion; 5) Implement capacity building activities for CRC screening in West Texas.

Achievable targets based on our prior program experiences are to directly provide 11,100 screening and diagnostic tests, 16,000 education services, 15,000 navigation services, 275 transportation services and 600 professional education services.

Innovative components are: 1) A coalition that includes all major hospitals and clinics serving the population in El Paso and Hudspeth Counties; 2) An implementation team to facilitate the uptake of evidence-based strategies, including tracking into clinical settings; 3) Creative dissemination strategies; 4) Non-traditional settings for delivery of screening services; 5) Leverage of resources to facilitate communication across systems; and 6) Directly addressing sustainability by design. S

This program meets the goals of the Texas Cancer Plan to reduce the impact of cancer in Texas through the implementation of sustainable and effective programs that target the underserved and reduce disparities in cancer throughout Texas.

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