• Increase to 80% the proportion of the Texas population who are aware that colorectal cancer screening can detect polyps, that removal of polyps can prevent colorectal cancer and that colorectal cancer is curable if detected early.

• Design and launch public awareness initiatives emphasizing risk factors and the importance of screening even in the absence of symptoms, what screening entails and why compliance over the long term is recommended.

• Tailor messages to appeal to the interests and values of specific audiences and utilize a variety of communication methods and venues with demonstrated success in reaching those audiences.

• Feature open discussion by public figures, optimally associated with Texas, to increase the comfort level of those who might be embarrassed or fearful.

• Forge working relationships with existing, highly credible community-based organizations, including churches, neighborhood centers and social clubs, to provide cancer information and support to their members and participants through educational forums, health fairs and “cancer ministries” (example, Appendix D).

• Schedule special concentration of the above-mentioned activities each March, during National Colorectal Awareness Month, and April, during National Minority Cancer Awareness Month.

• Collaborate with cancer information and education groups to examine existing materials for cultural sensitivity and relevance, identify gaps, develop new materials if needed, disseminate information and evaluate effectiveness.

• Convene key policy-makers in the public and private sectors, decision-makers in the insurance and healthcare industries and corporate executives to increase their knowledge about the benefits of colorectal cancer screening and secure their commitment to include coverage for it in employee health plans.

• Incorporate colorectal cancer screening into regular annual physical examinations for individuals age 50 or older, or earlier for those at greater than average risk, as a covered insurance benefit.

• Advocate increasing reimbursement for colorectal cancer screening services from Medicare, Medicaid and insurance plans to adequate levels to eliminate the current disincentive for healthcare providers to recommend them to their patients.

• Institute colorectal cancer screening criteria into the Health Plan Employer Data and Information Set (HEDIS) List of Measures, established by the National Committee for Quality Assurance.

• Distribute services on a regional basis within the state to increase their accessibility and coordination beyond what has been possible through the municipal or county framework.

Goal 3:
Increase access to and use of diagnostic services
and appropriate treatment and follow-up.

• Increase the number of Texas practitioners utilizing state-of-the-science treatments for colorectal cancer, including endoscopy, surgery and adjuvant treatments, as measured by baseline and post-intervention treatment procedure reports from institutions and private practice sites across the state.

• Establish a comprehensive and quickly accessible information source, such as an interactive website or telephone “hotline,” for healthcare providers relating to colorectal diagnosis, treatment, rehabilitation and after-treatment follow-up.

• Identify educational messages and methods for educating the public, colorectal cancer patients and their families about the concept of “continuum of care,” including appropriate diagnostic services, treatment and rehabilitation, nutrition counseling and other supportive services, effective symptom control, palliative care when needed and relevant survivorship issues.

• Assist health plans in implementing guidelines for positive survivorship.

• Add colorectal cancer screening to medical, nursing, residency and applied health curricula.

• Increase the number and scope of colorectal cancer educational programs offered by the POEP, NOEP, Oncology Nursing Society and other organizations that are targeted to family practice, internal medicine and ob-gyn physicians, residents and nurse practitioners.

• Redesign educational program content to make it more relevant to today’s healthcare environment, including current information on obtaining the maximum legitimate reimbursement for colorectal cancer screening services and the benefits of screening as sound medical practice management and possible litigation avoidance.

• Develop and disseminate “state-of-the-science” communiqués to keep physicians and other healthcare providers up to date on the prevention or early detection of colorectal cancer.

• Train nurses in ostomy and bowel management skills and collaborate with the Nurse Oncology Education Program, the Oncology Nursing Society and other professional nursing organizations to promote them.

• Train pharmacists and pharmacy students in bowel control and pain management pharmacology.

• Review current professional education materials regarding treatment options, including efficacy, side effects and quality-of-life post-treatment, for colorectal cancer and its precursors. Collaborate with the American Cancer Society and other professional organizations to identify informational gaps, develop new materials if needed, disseminate information and evaluate effectiveness.

• Provide valued recognition for training in colorectal cancer services, such as certification and continuing medical education credit.

• Assess primary providers’ knowledge and practices regarding patient referral to, and appropriate use of, treatment, supportive services and follow-up care of colorectal cancer survivors, including appropriate use of hospice, and design educational interventions accordingly using a variety of modalities.

• Utilize the findings of the Texas Medical Association survey on primary care physician knowledge, attitudes and practices regarding colorectal cancer screening to increase the number of physicians that promote screening to their patients. Identify current baselines for desired behaviors and set quantified goals for improvement within specific timeframes.

• Collaborate with the Department of Health to improve the usefulness of data obtained through the Behavioral Risk Factor Surveillance System, through contracted special surveys, expansion of the sample size and enhancement of questions asked about colorectal cancer screening.

• Survey members of the public, with special focus on those at increased risk for colorectal cancer, on their awareness, attitudes and practices relating to colorectal cancer prevention and screening. Collect and analyze data to determine the influence of race/ethnicity, location (notably, urban vs. rural areas), socioeconomics, gender and previous cancer diagnosis. Identify current baselines for desired behaviors and set quantified goals for improvement within specific timeframes.

• Pilot-test public awareness strategies and a screening intervention in a representative community to confirm what works most successfully and extend the results throughout the state.

• Assess Texas’ present capacity for and distribution of screening and treatment services, especially to the uninsured and underserved.

• Define and analyze the cost-effectiveness of colorectal cancer screening in Texas.