Abstract B76: Hope Through Grace, Inc.: A colon cancer prevention organization - 501 (C)(3) non-profit
Authors: Butler Grace 
Published: October 2015

Mission and Purpose: Hope Through Grace, Inc. (HTG) has adopted positive actions to raise awareness, increase understanding of colorectal cancer, confront mistrust of health care systems, and connect more people to prevention and early detection services titled Colorectal Cancer Education and Screening Program (CCESP). The intention of the CCESP is to provide practices for achieving higher rates of appropriate CRC screening: (1) increasing patient access to care; (2) improving effective communication about screening and screening options by trained educators (physicians or non-physicians) and patients; and (3) simplifying and coordinating organizational structures to better facilitate patients in completing screening.

Organization Mission: Eliminating colorectal cancer through prevention and early detection.

Public Health Issue Addressed: In Texas colorectal cancer ranks third in cancer incidence and second as a cause of cancer deaths of men and women. Significant differential rates of incidence and mortality are found across racial/ethnic groups. African-Americans have the highest incidence and mortality rates followed by Whites, and then Hispanics. Rankings specific to the Houston area are about the same. The gap in rates between Whites and Hispanics compared to African-Americans has actually increased. Regarding sigmoidoscopy/colonoscopy screening rates, in 2010, screening rates for African-Americans and Hispanics were much lower than for Whites.

Disparities in CRC incidence, mortality, and screening prevalence continue to be intractable. For African-Americans, incidence rates are 25% higher and mortality rates are about 50% higher than those among Whites.

Constituencies - Targeted, largely but not exclusively, are uninsured and medically underserved persons age 50 and older. The purpose is to educate, facilitate testing and motivate unscreened persons in the target area age 50+ to get screened.

Barriers and Overcoming Barriers: HTG addresses barriers that inhibit completion of screening procedures which are social structural and include poverty, lack of health insurance, and limited health education. Accordingly, personal barriers subject to alteration via persuasive communication which include alienation from the health care system, perceived lack of time availability, negative attitude towards the colonoscopy procedure, lack of significant others' support for screening, low self-efficacy, and fear of negative outcomes also are mitigated.

Program Aim - to promote health behavior changes, increase screening participation and reduce the number of persons diagnosed with colorectal cancer (CRC). Attainment of the following goals is the driving force for the agency.

Goal 1: Increase awareness of and access to culturally and linguistically appropriate colorectal cancer information that would be delivered to ethnically diverse and medically underserved populations.

Goal 2: Increase access to CRC prevention services, and thereby reduce racial, structural and financial barriers that are often present in medically underserved populations.

Goal 3: Increase awareness of appropriate CRC detection screening services.

Program/Services: HTG provides workshops, consultations, and seminars to populations at risk for developing colorectal cancer. Participant evaluations, used to measure effectiveness, uniformly convey the excellence and value of the sessions.

The organization covers the cost of baseline colonoscopies for the uninsured and working poor within our community. All participants must be asymptomatic for colon cancer, and all they are at risk of developing the disease due to age, family history, or personal history. Having no other place to turn to access the baseline colonoscopy, individuals sought financial support for screening services from our agency. Screening results were telling – many reports of multiple polyps, sessile polyps, diminutive polyps, diverticula, and multiple diverticula.

Health awareness information is provided through various media including radio, television and publications which results in extensive outreach to diverse audiences and significant face-to-face interactions at health fairs, intake seminars, and fundraising events. Our primary prevention, Educational/Motivational Program targets multiple variables in a theory-driven, evidence-based heuristic model. Enhancing subjects' healthy actions and screening behavior is leveraged by synthesizing several theoretical models from behavioral medicine. HTG uses a pipeline approach that navigates subjects through stages of motivation and behavioral change leading to baseline colonoscopy screening. The complete process entails the multiple phases of: 1) Outreach Meetings, 2) Health Education Initiatives, 3) Health Behavior Change, 4) Colonoscopy Screening, 5) Follow-Up and Referral. These process elements are expedited by one-on-one contact with clients, advocates and Health Educators.

Initiatives - Houston-area residents are provided with CRC prevention education and screening services. Uninsured and medically underserved people living in low-income areas are targeted, all of whom must be asymptomatic. Especially targeted are African-Americans 45 years of age and older residing in the Greater Houston area. However, program services are not limited by race or ethnicity. All individuals (who meet the guidelines for our target population) living in Harris County area are eligible.

Physicians and health educators provide information on colorectal cancer risk factors, risk reduction, nutrition, physical activity, improvement of health behaviors. Screening guidelines are presented, and with information regarding the guidelines, individuals are better able to make informed decisions about the screening procedure of their choice. After completion of the educational/motivational component of the program, participants are assisted with scheduling their CRC screenings; depending on their income level and insurance status, the organization covers costs of their baseline screening colonoscopies.

Since 2007, HTG has collected data and of the 173 colonoscopy screening participants, the majority were female (73%), and were African-American (54%). Further, 93% of the subjects were 50 years of age or older; 77% were employed, and 89% were uninsured. The majority (90%) were residents of Harris County. Most were uninsured (89%); those with insurance typically were Medicare recipients. Most participants were employed (77%) and all were required to demonstrate financial need of our services. Those individuals are considered to be working poor.

Only (33%) of those screened, were found to be negative for CRC. Among those not receiving a negative diagnosis, 17% were found with tubular adenomas, 25% were found with polyps, and 10% were found with diverticula. Two (2%) required referrals for additional services including surgery and treatment for late stage disease.

This model is replicable and includes the steps necessary “for achieving higher rates of colon screening: (1) increasing patient access to care; (2) improving effective communication about screening and screening options; and (3) simplifying and coordinating organizational structures to better facilitate patients in completing screening as identified by the RTI International-University of North Carolina Evidence-based Practice Center.

Partnerships with gastroenterologists and treatment agencies are essential; both increase participants' access to screening and ensure clinical care is available when recommended. Our wrap-around model for increasing awareness of CRC, access to trained medical professionals, and the number of uninsured and underserved who complete colonoscopies has decreased the incidence rates of CRC persons served in this program.

Citation Format: Grace Butler. Hope Through Grace, Inc.: A colon cancer prevention organization - 501 (C)(3) non-profit. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B76.