1. Susan G. Komen for the Cure Greater Amarillo Affiliate COMMUNITY PROFILE REPORT 2009

2. Acknowledgements The Greater Amarillo Affiliate of Susan G. Komen for the Cure wishes to thank everyone who helped to research, compile, and write this community profile. Many thanks to West Texas Family and Community Services, a project of the Psychology, Sociology and Social Work departments of West Texas A&M University, led by Sara E. Northrup, M.A., LBSW with assistance from Michael D. Nino, B.S. Without their research, this project could not have been successful. We also thank our current grantees, service providers, and key informants for their participation. Additionally, the affiliate thanks Lisa Hoff Davis, Executive Director, and Brandi Ruiz, Mission Coordinator, for their work leading the project and compiling information. Finally, thanks to Whitney Kelly, Affiliate President, for writing the words around the data. 3. Table of Contents Executive Summary.........................................................................................................................4 Introduction..................................................................................................................................4 Overview Demographic and Breast Cancer Statistics Key Findings...........................................4 Overview of Programs and Services Key Findings.....................................................................4 Overview of Exploratory Data Key Findings..............................................................................5 Narrative of Affiliate Priorities ...................................................................................................5 Affiliate Action Plan....................................................................................................................5 Introduction......................................................................................................................................7 Affiliate History...........................................................................................................................7 Organizational Structure..............................................................................................................7 Description of Service Area ........................................................................................................7 Purpose of Report........................................................................................................................7 Demographic and Breast Cancer Statistics......................................................................................8 Data Source and Methodology Overview....................................................................................8 Overview of Key Demographic & Breast Cancer Statistics at State and County Level.............8 Demographic and Breast Cancer Findings................................................................................11 Programs and Services...................................................................................................................13 Data Source and Methodology Overview..................................................................................13 Programs and Services Overview..............................................................................................13 Partnerships and Grant Opportunities .......................................................................................16 Promising Practices and Evidence-Based Programs..................................................................17 Public Policy Perspectives.........................................................................................................18 Programs and Service Findings.................................................................................................18 Exploratory Data............................................................................................................................19 Data Sources and Methodology Overview................................................................................19 Exploratory Data Overview.......................................................................................................19 Conclusions....................................................................................................................................21 Putting the Data Together..........................................................................................................21 Selecting Affiliate Priorities......................................................................................................22 Affiliate Action Plan..................................................................................................................22 List of Figures............................................................................................................................24 List of Tables ............................................................................................................................24 List of Appendices ....................................................................................................................24 Appendices.................................................................................................................................25 4. Executive Summary Introduction The Greater Amarillo Affiliate of Susan G. Komen for the Cure has held a Race for the Cure for the past nineteen years and became an affiliate in 2003. The paid staff of the affiliate consists of the Executive Director, Lisa Hoff Davis, and Mission Coordinator, Brandi Ruiz (Ms. Ruiz position began in the 2009-2010 fiscal year, reporting to the Executive Director). The chapter serves the top twenty-six counties of the Texas Panhandle, an extremely large and mainly rural area. The population of the area is clustered in a few of the cities with a total population of approximately 413,000. This profile discusses the characteristics of the service area and breast cancer statistics for the area. It also provides an overview of programs and services available for breast health, explores findings of breast cancer incidence and mortality for the area, lists the affiliates priorities for programs and grant funding, and details the affiliates plan of action for the next two years. Overview Demographic and Breast Cancer Statistics Key Findings The initial data used was provided by Thomson Reuters 2007 and Claritas Inc (2007) through the Greater Amarillo Affiliate of Susan G. Komen for the Cure. The secondary data provided qualitative and quantitative data for twenty-six counties in the Texas Panhandle. The figures provided by Claritas Inc (2007) also provided quantitative data regarding breast cancer and breast health throughout the United States. Key Findings: 1. Twenty-two out of the twenty-six counties in the Greater Amarillo Affiliate area are over the highest (113.7) state average incidence rates. The affiliate should prioritize screening and support for these 22 counties: Armstrong, Donley, Briscoe, Childress, Collingsworth, Roberts, Hall, Wheeler, Carson, Gray, Swisher, Oldham, Lipscomb, Randall, Hutchison, Hemphill, Sherman, Castro, Potter, Hartley, Hansford, and Moore. 2. Almost 40 percent (39.4%) of women over the age of 40 reported not receiving a mammogram in the last twelve months. 3. Caucasian women are represented consistently in all four stages of breast cancer. However, African American women have higher rates of stage 3 and 4 breast cancer when compared to other ethnic groups. Overview of Programs and Services Key Findings Information for the breast cancer programs and services of the service area was collected through internet research, key informant interviews, and historical review of service providers. Information was collected at the county, city, and service area levels. After collecting all sources of breast cancer programs, staff reviewed all of the data for detailed schedules, services, program availability, and funding sources. The profile includes a listing of all service providers. Services are scattered across the Panhandle, and treatment facilities are located only in Amarillo. Due to the small number of service and treatment providers, many 5. women do not have access or have limited access to education, screening, and treatment for breast health. Overview of Exploratory Data Key Findings The exploratory data collected for the community profile brought up more opportunities for research. The affiliate understands that a larger sample size would produce statistically relevant information. However, addressing the response rate to surveys will have to be improved first. The affiliate has identified barriers to services, the cultural and behavioral considerations related to health care, effect of location on services (rural vs. urban), and best methods to supplement the statistical information as topics for further exploratory research. Narrative of Affiliate Priorities After reviewing breast cancer statistics for the twenty-six counties of the Texas Panhandle, examining the available programs and services, and incorporating exploratory data, the affiliate has identified the following priorities for the upcoming two years: 1. Target underserved women: 10% of families fall below the poverty line, 31% of women are uninsured, and 40% of women over forty did not get an annual mammogram. 2. Focus funding in six counties: Gray, Hansford, Potter, Randall, Dallam, and Carson. These counties are home to 67% of the Panhandles population while also representing high incidence and counties with service providers. The counties are also adjacent to counties without service providers so the affiliate can investigate rural versus urban obstacles to service. 3. Encourage partnerships: The expected success of the WISE Woman Project and the coordination of services created by the project highlight the potential for additional partnerships. Increased partnership and coordination with the BCCCP will stretch funding dollars and ensure more women have access to screening and diagnosis. 4. Address cultural and ethnic obstacles to education, screening, and diagnosis: Although Caucasian women are more than half of the population, the minority groups of the Panhandle are expected to grow faster than the Caucasian group during the upcoming census. Caucasian women have traditionally had better access to healthcare, so emphasis on minority groups will provide data for future programs and grant opportunities. Affiliate Action Plan The affiliates action plan details how it will increase success in the areas of community partnerships, building on best practices in existing grants, improving public policy efforts (especially with the BCCCP), and increase education and outreach opportunities. 6. Community Partnerships The affiliate will pursue additional community partnership opportunities and will encourage grantees to engage in partnership activities. This supports item 3 of the priority list and ensures grant funding makes the greatest impact on the community. Existing Grant Solutions The affiliate has already begun to address some of the issues uncovered by the community profile. The WISE Woman Project is a new partnership of both new and previous grantees working together to serve low income, minority women in two of the target counties. Also, the Texas AgriLife grant is providing education opportunities across the entire service area. Both grants provide opportunities for future best practices to address the affiliates priorities. Needed Grant Opportunities Future grant opportunities should expand existing grant work. Future grants should bring more education and screening to rural areas (like the Texas AgriLife grant), focus on serving low income and minority women (like the WISE Woman Project), or address the high incidence and mortality of the targeted counties (like all of the existing grantees). The affiliate ensures future grantees will understand and address these needs by conducting annual grant writing workshops with the help of the Cancer Information Service of the National Cancer Institute. Public Policy Efforts In order to improve the affiliates coordination with the BCCCP funding, staff will begin work with the Texas Director (or her designee) to discuss ways to improve the 3% of women who are eligible for services. Education and Outreach Education and outreach continue to be high priorities for the affiliate. Through both quantitative and qualitative data, the affiliate learned that women throughout the service area did not know how to access services or were ignorant of basic breast health concepts. The affiliate will continue to work for additional education opportunities: its recent hiring of a Mission Coordinator demonstrates its commitment to education. The community profile uncovered the need to address cultural and ethnic barriers to service which the affiliate will incorporate into future grant requests. 7. Introduction Affiliate History The Greater Amarillo Affiliate of Susan G. Komen for the Cure has held races for the past nineteen years, but became an affiliate in 2003. Two paid staff shared the Executive Director position 2003-2005 and the current Executive Director was hired in 2005. The chapter has sustained continuous and admirable growth throughout its history. For grant year 2009-2010, the chapter awarded $217,000 to its grant recipients. Organizational Structure The paid staff of the affiliate consists of the Executive Director, Lisa Hoff Davis, and Mission Coordinator, Brandi Ruiz (Ms. Ruiz position began in the 2009-2010 fiscal year, reporting to the Executive Director). Ms. Davis reports to the eleven-member board of directors. Description of Service Area The chapter serves the top twenty-six counties of the Texas Panhandle: an extremely large and mainly rural area. The population of the area is clustered in a few of the cities with a total population of approximately 413,000. Area service providers draw clients from across the service area. Treatment providers are located in the center of the service area in Amarillo, so patients seeking treatment for breast cancer must travel to Amarillo for radiation or chemotherapy. Figure 1 Purpose of Report This profile will discuss in detail the characteristics of the service area and breast cancer statistics for the area. It will also provide an overview of programs and services available for breast health, explore findings of breast cancer incidence and mortality for the area, list the affiliates priorities for programs and grant funding, and detail the affiliates plan of action for the next two years. 8. Demographic and Breast Cancer Statistics Data Source and Methodology Overview Breast cancer is the most common form of cancer in women throughout the world. A recent study estimated 1.15 million women were diagnosed with breast cancer and 411,000 died from it in 2002. Currently, there are approximately 4.4 million women living who have been diagnosed with breast cancer in the past five years throughout the world. Breast cancer incidence rates continue to rise with a 30-40 percent increase from 1970s to the 1990s, but more rapidly in developing counties. Just in the United States alone over 192,000 women will be diagnosed with breast cancer this year (American Cancer Society). Breast cancer and breast cancer awareness continues to be a major concern in the United States. However, increased public discussion concerning breast health does not always translate into improved breast health practicesalthough research has shown early detection of cancer through mammography can improve a persons survival rate. The following examines breast health, breast health practices, knowledge of breast health and willingness to seek out medical information regarding breast health in twenty-six counties in the Texas Panhandle. The objective is to identify gaps in services in the twenty-six counties, in order to lessen breast cancer mortality rates in the Texas Panhandle. Data Source and Methodology Review: The initial data used was provided by Thomson Reuters 2007 through the affiliate. The secondary data utilized was Claritas Inc (2007) through West Texas A & M University. Initial data led to process 6 target areas and was reviewed. Secondary data provided qualitative and quantitative data for the six target areas. From the review it was determined to further investigate by using a survey mailed to a database created by Claritas 2007 and maintained by WTAMU. The study is exploratory, so the raw data was first reviewed. Once the data was reviewed specific questions began to emerge just purely from observation. As the data was thoroughly reviewed, the Community Profile committee utilized multiple methods of research to complete the Community Profile. The committee used various types of data; specifically: 1. Demographic Data (age, race, education etc) 2. Specific breast health/cancer data (Incidence, Morality, and Prevalence) 3. Community Resources data obtained from a self-reported survey (N= 58) Overview of Key Demographic & Breast Cancer Statistics at State and County Level In order to understand the severity of breast cancer in the Texas Panhandle the affiliate first examined breast cancer rates at a national level. For the purposes of this study the total female population and the prevalent breast cancer cases for the 10 largest states were examined. The prevalent breast cancer rates compared to states total population are fairly small; however, when examining prevalent breast cancer 9. cases for Texas and California, Texas had a higher ratio rate than California. The ratio for females diagnosed with breast cancer in California for 2007 is approximately 1 out of every 244; comparatively in Texas 1 out of every 222 were diagnosed with breast cancers in 2007. The Greater Amarillo Affiliate of Susan G. Komen for the Cure covers twenty-six counties in the Texas Panhandle. For the purposes of this study all twenty-six counties were analyzed. Once the initial data was analyzed for all twenty-six counties, six primary counties were identified for a deeper analysis using a survey developed by the profile team. The twenty-six counties are: Potter, Randall, Hutchison, Gray, Moore, Deaf Smith, Parmer, Ochiltree, Dallam, Swisher, Childress, Castro, Carson, Hansford, Wheeler, Donley, Hall, Hemphill, Lipscomb, Collingsworth, Hartley, Sherman, Oldham, Armstrong, Briscoe and Roberts. 10. The chart below shows estimated breast cancer rates for all of the counties of the Panhandle: Breast Cancer Prevalence by County Area: Greater Amarillo Affiliate Ranked by Prevalent Breast Cancer Cases (Desc) National Average Age for Prevalence of Breast Cancer: 59.1 FIPS Prevalent Avg Age for County 2007 Female Breast Cancer Prevalence of Code County State Population Cases Breast Cancer 48381 Randall TX 57,044 271 58.2 48375 Potter TX 59,940 271 59.7 48179 Gray TX 10,581 56 61.7 48233 Hutchinson TX 11,214 56 60.3 48117 Deaf Smith TX 9,507 39 59.5 48341 Moore TX 10,077 36 58.7 48369 Parmer TX 4,890 21 60.1 48437 Swisher TX 3,646 19 61.4 48111 Dallam TX 4,461 19 59.7 48357 Ochiltree TX 4,730 19 59.0 48069 Castro TX 3,674 17 60.3 48075 Childress TX 2,984 17 61.4 48065 Carson TX 3,267 17 60.3 48483 Wheeler TX 2,403 13 61.7 48129 Donley TX 2,034 12 62.0 48195 Hansford TX 2,691 12 60.9 48191 Hall TX 1,928 11 62.4 48087 Collingsworth TX 1,532 9 62.3 48211 Hemphill TX 1,665 8 60.1 48295 Lipscomb TX 1,550 8 61.4 48011 Armstrong TX 1,153 7 61.6 48421 Sherman TX 1,327 6 59.8 48359 Oldham TX 1,073 5 59.3 48045 Briscoe TX 805 5 61.7 Table 1 Based on population and reported breast cancer information, twenty counties were excluded from further study. For many of the counties, cancer information was suppressed due to the small number of cases. For other counties, their small populations coupled with the small number of cases of breast cancer made them unable to be examined with statistical accuracy. 11. Demographic and Breast Cancer Findings The average incidence rates for the state of Texas range anywhere from 96.4 to 113.7 according the Centers of Disease Control and Prevention. The second gap that is the most alarming is twenty-two out of the twenty-six counties in the Greater Amarillo Affiliate area are over the highest (113.7) state average incidence rates. The affiliate should prioritize screening and support for these 22 counties: Armstrong, Donley, Briscoe, Childress, Collingsworth, Roberts, Hall, Wheeler, Carson, Gray, Swisher, Oldham, Lipscomb, Randall, Hutchison, Hemphill, Sherman, Castro, Potter, Hartley, Hansford, and Moore. Race: Racial disparities in breast cancer cases for all four phases were examined using data provided by Claritas Inc (2007). Once the necessary data was complied and analyzed, the results showed Caucasian women have the most consistency across all counties with all four stages of breast cancer. The results also showed African American women have a higher rate of stages 3 and 4 of breast cancer compared to the other ethnic groups. The overall results of the data helped to develop more in-depth questions regarding race that would be administered in the survey of six counties mentioned earlier. It is apparent that there are some disparities among ethnic groups; however, further research must be employed to explore these disparities. Findings: This study set out to examine breast health issues in the upper twenty-six counties of the Texas Panhandle. The survey data and data provided by Thomson Reuters 2007 and Claritas Inc. (2007) provided the framework for the following conclusions. First, twenty-two out of the twenty-six counties were found to have among the highest average incidence rate of breast cancer in the state. Additionally, these rates played out in comparison with another state. As previously mentioned, Texas has a higher ratio rate for women diagnosed with breast cancer than California. Even though California is more densely populated, Texas has more breast cancer cases. These high rates of incidence beg further examination. The study found, among those surveyed, 40% of women over forty were not receiving annual mammograms for a variety of reasons. This is only one of three recommended steps for early detection. Targeted, continued education is a clear indication for this age group. Finally, Caucasian women are represented consistently in all four stages of breast cancer. However, African American women have higher rates of stage 3 and 4 breast cancer when compared to other ethnic groups. Targeted educational campaigns could assist in a rate reduction in this particular group. 12. Programs and Services Data Source and Methodology Overview Information for the breast cancer programs and services of the service area was collected through internet research, key informant interviews, and historical review of service providers. Information was collected at the county, city, and service area levels. After collecting all sources of breast cancer programs, staff reviewed all of the data for detailed schedules, services, program availability, and funding sources. Information and additional sources of information were collected from the Lubbock Affiliate of Susan G. Komen for the Cure, Texas Department of State Health Services, M.D. Anderson Hospital, American Cancer Society, Harrington Cancer Center, Baptist St. Anthonys Health System, and United Way of Amarillo and Canyon. Programs and Services Overview For this project, staff collected all breast healthcare providers in the twenty-six county service area and compiled the contact information. This list represents fewer providers than are usually found in a large metropolitan area and shows how important the few providers are to this large region. Because the Comprehensive Breast Center of the Harrington Cancer Center and Texas Oncology are the only providers of chemotherapy and radiation treatment for breast cancer in the Panhandle, some women may drive more than 100 miles for treatment. Although there are a few locations for mammography and mobile mammography programs, they are scattered across the service area and may still require women to drive more than an hour for screening. The scarcity of service providers creates many problems for access to healthcare due to transportation issues and difficulty for follow- up care. 13. Below is a listing of all breast healthcare providers in the twenty-six counties of the Texas Panhandle: Breast Healthcare Providers by County County (or service area) Program/Service Provider Armstrong County Coalition of Health Services Inc. Claude Medical Clinic 201 S. Park Claude, TX 79019 (806) 226-5611 Childress Coalition of Health Services, Inc., Fox Rural Health Clinic Highway 83 North Childress, TX 79201 (940) 937- 9654 Gray Pampa Regional Medical Center-Womens Health Clinic 1 Medical Plaza Pampa, TX 79065 (806) 663-5663 Hall Fox Rural Health Clinic Highway 83 North Childress, TX 79201 (940) 937-9654 Hansford Family Medical Center of Hansford County 702 S. Roland Spearman, TX 76081 (806) 659-2846 Hemphill Hemphill County Hospital-Harrington Cancer Center Mobile Mammography 1020 S. 4th Canadian, TX 79014 (806) 359-4673 Ochiltree Perryton Health Center 3101 Garrett Dr. Perryton, TX 79070 (806) 435-7224 Potter/ Randall (Amarillo and Panhandle region) Texas Panhandle Family Planning Health Centers 1501 S. Taylor Amarillo, TX 79101 (806) 372- 8746 Comprehensive Breast Center of the Harrington Cancer Center 1310 Wallace Blvd. Amarillo, TX 79106 (806) 356-1905 Northwest Women and Children Clinic 814 Martin Rd. Amarillo, TX 79107 (806) 342-4789 Texas Oncology 1000 S Coulter St # 100, Amarillo, TX 79106 (806) 358-8654 Northwest Texas Hospital Womens Imaging Center 1501 S. Coulter Amarillo, TX 79106 (806) 354-1000 Womens Healthcare & Associates 1301 S. Coulter Amarillo, TX 79106 (806) 355-6330 Sherman Stratford Clinic 1220 Purnell PO Box 1107 Stratford, TX 79084 14. The map below illustrates incidence of breast cancer incidence and mortality 2001-2005. Service providers are current as of 2009. Red pins reflect mortality per 100000 1=22.6-24.0 2=24.1-26.3 3=26.4 - 28.5 4= 28.6-42.9 Screening Mobile Mammography Treatment Incidence Cases per 100,000 Level 1 (104.4-112.1) Level 2 (104.4-112.1) Level 3 (112.1-119.8) Level 4 (119.9-128.4) Level 5 (128.5-308.7) 15. Figure 2 Because of the scarcity of providers for breast healthcare, the women of the Texas Panhandle have many impediments to service. Only eleven of the twenty-six counties have service providers, so a woman is more likely to have to travel outside her county than to receive service in her home county. Mammograms are provided in Amarillo, Hereford, and Dumas only. For mammograms in other towns, women rely on the mobile mammography unit of Harrington Cancer Center (For a detailed schedule of locations, see https://secure.harringtoncc.org/fileadmin/files/forms/comprehensive_breast_center/OUT REACH_DATES_2009.pdf). For women diagnosed with breast cancer, they have only two locations for treatment, both in Potter County. This scattering of service providers mirrors the problems identified through surveys and key informant interviews: many women do not have regular mammograms which leads to higher mortality rates throughout the area. Partnerships and Grant Opportunities The Greater Amarillo Affiliate of Susan G. Komen for the Cure currently partners with the Amarillo Area Breast Health Coalition to fund and support the WISE (Women Inspiring, Serving, and Educating) Woman Project. This project trains selected women in low income housing communities to educate their neighbors and friends about access and use of available breast health programs. The project began in August 2008 and the first women were trained in April 2009. The project has the potential to reach hundreds of women and builds additional partnerships with American Cancer Society, American Housing Foundation, Texas Tech University Health Sciences Center (Laura W. Bush Institute for Womens Health and School of Medicine), Baptist St. Anthonys Health 16. System, and Harrington Cancer Center. For the project, Komen for the Cure acts as the funding source for most of the program with other partners providing staff, services, and in-kind donations. It also provides seamless services for traditionally underserved women who do not regularly receive mammograms. Through the WISE Woman Project, a woman can receive breast health information and instruction about access to mammograms, participate in mammogram events to receive a Komen-funded mammogram, and then be referred to another partner for treatment and support. The project includes transportation and child care in order to remove the two most frequently cited reasons for not being able to access services. In addition to this project, Komen Amarillo is excited about its current grantees and its increased reach across the service area. Beginning in the 2009-2010 grant cycle, the affiliate has granted funding for a project of the Texas A & M AgriLife Extension to educate older, rural women about breast health screening and funding for appropriate services. The AgriLife Extension has offices in all counties of the Panhandle and will be able to reach women who have not been served by other grants. Another grant that is reaching across the Panhandle is being conducted by Amarillo Colleges public broadcasting television station, KACV. KACV will produce and broadcast public service announcements about breast health in both English and Spanish. Because KACVs service area mirrors Komen Amarillos, the affiliate sees this grant as a great way to both publicize Komens impact on the area and make breast health information available to all women in the Panhandle. Other current grantees include Amarillo Girl Scouts and Harrington Cancer Center. Under the Girl Scouts grant one event will educate girls and women about breast cancer risk factors and early detection methods. Under the Harrington Cancer Center grant, Komen provides screening and diagnostic mammography for medically underserved women. It especially targets women who are 18-35 years old and have high risk factors for breast cancer. Because Harrington is a BCCCP provider, the center maximizes available funding by determining which funding source better serves the patient. Because BCCCP funds have been decreasing, Komen funds have become critical for providing mammograms for underserved women. Based on current grants, Komen Amarillo is successfully attempting to reach all of its service area and women who can benefit from breast health education, programs, and services. However, the performance of the grants will determine the success of the programs. The affiliate will continue to encourage entities that serve the entire Panhandle to apply for funds. Until additional service providers can be found, Komen Amarillo hopes to continue to fund Harrington Cancer Center and its programs for low income, underserved women. Promising Practices and Evidence-Based Programs For this funding cycle, grantees, medical professionals, and community members attended a grant workshop hosted by the affiliate and facilitated by the National Cancer Institute; most of them have included evidence-based objectives in their grants. The affiliate has already begun to plan the workshop for 2010 and expects to conduct it yearly for existing and potential grantees. This will ensure all grantees incorporate evidence-based programs and best practices from other grantees. 17. The WISE Woman Project, AgriLife grant, and Harrington Cancer Center grant have strong components of objective measurement and community impact: the affiliate will know exactly how many women receive education, screening, diagnosis, and treatment. Public Policy Perspectives Komen Amarillo coordinates services with the BCCCP through the services of Harrington Cancer Center, the main provider of cancer screening and treatment for the Texas Panhandle. For the past few years, funding from BCCCP has been declining, so Komen Amarillo has recently allowed the Cancer Center to revise its grant to include women of all ages. Although more than 134,000 women have been served since 1992 through the BCCCP (Dorothy Marley, BCCCP representative), only about 20,000 Texas women are served each year, reaching a mere 3% of those who are eligible for services. The director of BCCCP for Texas is Emelda Garcia. The affiliate has not built a relationship with her, but will plan to begin to coordinate with her during the next few years to improve womens access to the BCCCP funding and services. The affiliate has a much better relationship with all of its elected officials. The Amarillo mayor, Debra McCartt has been a regular supporter and participant in the Race for the Cure. The Executive Director has recently lobbied both state and national representatives. In January 2009, Ms. Hoff Davis met with Senator Kel Seliger and Representatives David Swinford, John Smithee, and Warren Chisum. In April 2009, she travelled to Washington, D.C. to meet with Senators Kay Bailey Hutchison and John Cornyn and Representatives Mac Thornberry and Randy Neugebaur. The affiliate has good working relationships with state representatives and will strive to improve the relationships with its national elected officials. Programs and Service Findings From a thorough review of the available programs and services of the Texas Panhandle, the affiliate affirmed its understanding of the thin coverage of its service area. Many women do not have access to basic services and programs. The affiliate continues to initiate discussions with the regions healthcare centers about grant opportunities through Komen for the Cure. During the collection of exploratory data, the researchers investigated how women accessed healthcare and what the women perceived as barriers to service. 18. Exploratory Data Data Sources and Methodology Overview The SGK data packs provided by Thomson Reuters 2007 have given an excellent insight into local cancer estimates. There are questions that require further exploration in the overall assessment process. This additional, subjective data will be collected from surveys, focus groups and other methods identified in community data. The following are identified for further study: What are the barriers to services? What are the cultural and behavioral considerations related to health care? What effect does location have on services (rural vs. urban)? What is the best method to supplement the statistical information? As this information is preliminary, further study will produce more conclusive results. Exploratory Data Overview A basic questionnaire was developed to attempt to fill in some of the gaps observed in the initial data analysis. The survey instrument assessed basic demographic information; as well as pertinent questions regarding access to health care and health care/breast health practices. In order to obtain the most accurate and non- biased results 525 questionnaires were sent out the six primary counties via mail. Attached in the envelope was a consent form outlining the objective of the study and a post marked return envelope. This was to ensure a high return rate of completed questionnaires. Respondents were limited on the amount of time they had to return the 19. filled questionnaire and signed consent. Unfortunately we were only able to obtain 58 completed questionnaires. This could have been for a number of reasons; the amount of time allotted, the subject matter, not of interest, etc. The basic demographic data showed age ranged from 26 to 86 years of age with 51 being the median age. The majority of the respondents were from Gray County (41.4%); however, Hansford (17.2%), Potter (15.5%), Randall (10.3%), Dallam (10.3%), and Carson (5.2%) produced respondents. The majority of the respondents were Caucasian (91.4%), with Hispanic (6.9%) and American Indian (1.7%) representing the rest of the total population. The respondents educational background varied with the majority have a high school diploma (46.6%), followed by Bachelors Degree (20.7%), Associates Degree (13.8%), Masters Degree (8.6%), GED (5.2%), PhD/M.D (3.4%) and No formal education (1.7%). The section of the survey dedicated to the breast health and breast cancer knowledge produced some interesting results. Of the 58 respondents 86.2% reported having easy access to medical services, 96.6 % reported having received information concerning self-breast exams, and 91.4% receiving information on breast cancer and breast health, 100% reported that mammograms are important to womens overall health. When respondents were asked if they had ever received a mammogram (82.8%) and if they had received a mammogram in the last twelve months (60.3), an overwhelming majority reported yes. Also, almost ninety percent (87.7) of respondents reported receiving annual physical exams. Those respondents who reported never receiving a mammogram or not receiving a mammogram in the last twelve months were asked why not: interestingly, the majority of the responded to the other category (26.7%), followed by to expensive/no insurance (20%), havent had any problems (20%), put it off/ too lazy (16.7%), didnt know I needed it (3.3%), and never thought about it (3.3%). Those who marked the other category were given the opportunity to specify their reason here were some of the most common responses: Dr. suggested waiting until age 40 It was not due Needs to be done every two years Breast Feeding Scared Dr. Moved Away 20. Conclusions Target Area Findings From the quantitative and qualitative data collected for the Community Profile, the affiliate discovered many areas of attention in the Texas Panhandle. First, twenty- two out of the twenty-six counties were found to have among the highest average incidence rate of breast cancer in the state. These high rates of incidence beg further examination. The study found, among those surveyed, 40% of women over 40 were not receiving annual mammograms for a variety of reasons. Clearly, targeted and continued education is indicated for this age group. Additionally, Caucasian women are represented consistently in all four stages of breast cancer. However, African American women have higher rates of stage 3 and 4 breast cancer when compared to other ethnic groups. Targeted educational campaigns could assist in a rate reduction in this particular group. Research also confirmed the affiliates understanding of the thin service coverage of the area: Many women do not have access to basic services and programs. The affiliate continues to initiate discussions with the regions healthcare centers about grant opportunities through Komen for the Cure. Barriers to service and rural versus urban access will become a priority for further investigation during the next two years. Finally, the exploratory data helped the affiliate identify barriers to services, the cultural and behavioral considerations related to health care, effect of location on services (rural vs. urban), and best methods to supplement the statistical information as topics for further exploratory research. Putting the Data Together Because of the suppressed data (due to small numbers) in many of the service area counties, the affiliate removed many of the counties from further study. Additionally, the small number of service providers also limited the opportunities for further investigation. After examining incidence and mortality for available counties, the affiliate paired the service providers to counties with high incidence or mortality from breast cancer. Then, based on responses to surveys, the affiliate uncovered the recurring themes of high incidence and mortality due to limited access to services and educational needs based on the sparse service providers and few education opportunities. 21. Selecting Affiliate Priorities After reviewing breast cancer statistics for the twenty-six counties of the Texas Panhandle, examining the available programs and services, and incorporating exploratory data, the affiliate has identified the following priorities for the upcoming two years: Target underserved women: 10% of families fall below the poverty line, 31% of women are uninsured, and 40% of women over forty did not get an annual mammogram. Focus funding in six counties: Gray, Hansford, Potter, Randall, Dallam, and Carson. These counties are home to 67% of the Panhandles population while also representing high incidence and counties with service providers. The counties are also adjacent to counties without service providers so the affiliate can investigate rural versus urban obstacles to service. Encourage partnerships: The expected success of the WISE Woman Project and the coordination of services created by the project highlight the potential for additional partnerships. Increased partnership and coordination with the BCCCP will stretch funding dollars and ensure more women have access to screening and diagnosis. Address cultural and ethnic obstacles to education, screening, and diagnosis: Although Caucasian women are more than half of the population, the minority groups of the Panhandle are expected to grow faster than the Caucasian group during the upcoming census. Caucasian women have traditionally had better access to healthcare, so emphasis on minority groups will provide data for future programs and grant opportunities. Affiliate Action Plan Community Partnerships The affiliate will pursue additional community partnership opportunities and will encourage grantees to engage in partnership activities. This supports item 3 of the priority list and ensures grant funding makes the greatest impact on the community. Existing Grant Solutions The affiliate has already begun to address some of the issues uncovered by the Community Profile. The WISE Woman Project is a new partnership of both new and previous grantees working together to serve low income, minority women in two of the target counties. Also, the Texas AgriLife grant is providing education opportunities across the entire service area. Both grants provide opportunities for future best practices to address the affiliates priorities. Needed Grant Opportunities 22. Future grant opportunities should expand existing grant work. Future grants should bring more education and screening to rural areas (like the Texas AgriLife grant), focus on serving low income and minority women (like the WISE Woman Project), or address the high incidence and mortality of the targeted counties (like all of the existing grantees). The affiliate ensures future grantees will understand and address these needs by conducting annual grant writing workshops with the help of the Cancer Information Service of the National Cancer Institute. Public Policy Efforts In order to improve the affiliates coordination with the BCCCP funding, staff will begin work with the Texas Director (or her designee) to discuss ways to improve the 3% of women who are eligible for services. Education and Outreach Education and outreach continue to be high priorities for the affiliate. Through both quantitative and qualitative data, the affiliate learned that women throughout the service area did not know how to access services or were ignorant of basic breast health concepts. The affiliate will continue to work for additional education opportunities: its recent hiring of a Mission Coordinator demonstrates its commitment to education. The community profile uncovered the need to address cultural and ethnic barriers to service which the affiliate will incorporate into future grant requests. 23. List of Figures Figure 1: Service Area Map Figure 2: Resource Map List of Tables Table 1: Breast Cancer Prevalence by County Table 2: Breast Healthcare Providers by County List of Appendices Appendix A: Focus Group Sample Questions Appendix B: Key Informant Interview Sample Questions Appendix C: Survey Request Appendix D: Consent Form Appendix E: Key Informant Survey Appendix F: Key Informant Interview Guide Appendix G: Survey Scripts Appendix H: National and Texas Breast Health Program and Service Providers 24. Appendices Appendix A: Focus Group Sample Questions 1. Do you go to the doctor regularly? Do you have a local healthcare provider? 2. Where is someone most likely to go for breast health information? 3. What does breast health screening mean to you? Do you know the recommended guidelines for breast health screening? 4. If you didnt have insurance, what would you expect to pay for a mammogram? 5. What do you think are the barriers that prevent women from seeking or getting breast health screening in your community? Examples if no one is responding: a. Transportation b. Financial/Uninsured c. Lack of facilities/providers for your community 6. What could your doctor do to encourage women to seek breast health services? Examples if no one is responding: a. Reminder at each visit b. Link you to program/service that would help pay c. Nothing, I would need insurance first 7. What type of program could we provide to make it easier for women to access breast health services? Examples if no one is responding: a. Mobile Mammogram Units b. Transportation/Vouchers c. Awareness Campaigns d. Helpline/Hotline (with translators) 8. Who could we partner with in your community to best get the word out about breast health to women in this community? 9. What does Susan G Komen for the Cure mean to you? a. Do you know what we do in the Columbus Community? Survivors 1. Did you have any difficulty finding providers/services? 2. What was the most difficult and most beneficial aspect of your breast cancer experience? 3. What programs/services would you recommend to other survivors? What advice would you give them? 4. How much did financial considerations affect your treatment decisions? Did your work schedule impact your decisions? 5. What services were missing? Support Groups, survivorship programs, after-care, etc 6. In your community, where should Komen prioritize its funding: Education, Screening, Treatment, Survivorship? 25. Appendix B: Key Informant Interview Sample Questions Key informant interviews should include five to ten questions that provide in-depth understanding to specific areas of focus. Initial scripted questions start the discussion, but the interviewer should always probe and ask more questions to clarify dialogue and get as much information as possible on the topic. The questions created by the community profile team should always be tailored to who is being interviewed. Additionally, the questions should address the gaps in knowledge that still exist after collecting and reviewing demographic data, breast cancer statistics and program and services reports. Data collected using key informant interviews will only be as good as the questions the community profile team creates to address the real issues in the community. When creating the questions, the team should always ask the following: Why do we want to know this? Who will be interviewed? i.e. provider, community member, etc. Is this going to lead to areas we can address? How will this inform our (grants process, marketing, education) efforts in the community? When creating the questions, the team should remember these rules: Use open-ended questions Avoid questions that can be answered with yes or no Focus the questions from general to specific The questions provided here are examples that may help the community profile team understand what types of questions to create for and ask of a key informant. Key Informant Sample Questions (Providers) 1. How would you describe the women who are least likely to be getting regular breast health screening? a. What neighborhoods do these women live in? b. Where do they work? c. What businesses do they frequent? d. Describe their ethnic background. e. What are their family situations like? 2. How would you describe the women who are least likely to receive effective breast health services? * see above probing questions 3. How successful is the current healthcare system in meeting the needs for breast healthcare and treatment? 26. 4. How effective are the financial assistance programs in your community in helping women access breast health services? 5. What types of programs do you think would help to improve the current system? 6. If funding was made available, is your organization willing (alone or in partnership) to provide services that expand on existing services or address gaps in services? 7. How can organizations working in the field of breast cancer collaborate more? 8. What are some of the barriers to collaboration in your community? 9. Are there specific breast health partnerships that could be formed to address specific breast health gaps in your community? 10.What would a Komen partnership with your organization look like? 11.What laws or policies make it difficult for women to get breast health services in your community? 12.What efforts, if any, does your organization make to market breast health information in your community? 13.What policies do insurance providers follow related to clinical trial coverage in this community? Key Informant Sample Questions (Survivorship) 1. When and where was the cancer diagnosed? 2. Were you advised of your treatment options? 3. What stage was the cancer when detected? 4. When did you begin to receive treatment? 5. What stage was the cancer when treatment began? 6. How has this affected your life physically, financially, and emotionally? Interviewing Tips Use probing techniques to encourage conversation without influencing the answer. Two kinds of probes are used for open-ended questions probing for clarity and probing for additional information. The best probes for clarity are the ones that tell the respondent exactly what you need to know, or what you want them to do. For example: What do you mean? Could you be more specific? Could you tell me more about ____? Could you give me an example? Once a clear response has been given, the interviewer can probe for additional responses to the question. The best way to do this is to repeat the main point of the question as part of a request for further information. For example: What else do you think? What other reason exist? Avoid asking is there anything else because this can be answered with NO. 27. Appendix C: Survey Request April 9, 2009 The Greater Amarillo Affiliate of Susan G. Komen for the Cure is seeking female participants for a research study. You have been randomly selected to participate in this study. The title of this study is: Factors in Womens Breast Health: A Survey of Six Texas Panhandle Counties The purpose of this exploratory, descriptive study is to examine medical and educational resources for women regarding breast cancer in six counties of the Texas Panhandle. The counties that will be explored are Carson, Dallam, Gray, Hansford, Potter and Randall. There are few risks in participating in this study. You may feel uncomfortable about answering some of the questions in the survey instrument. You may opt out at any time and may choose to leave questions unanswered. Your participation is strictly voluntary and is confidential; there will be no way to link your answers with your name. Data will be reported in aggregate form only. By participating in this study, you may help us generate a better understanding of what kind of problems women might face, and if their needs are being met regarding breast health and other related variables. These variables have been identified as being important and relevant to social work practice in todays society and will help in developing new and progressive services in the Komen service area. Participation will require approximately 2-5 minutes of your time. If you agree to participate, please fill the attached survey and return it to: In order to compile this sensitive data in an effective and efficient manner, we ask you to please return the survey in the attached envelope by April 23, 2009. Your participation in this study is greatly appreciated and we would like to say thanks on behalf of the Greater Amarillo Affiliate of Susan G. Komen for the Cure and the many fighting breast cancer. Sincerely, Sara Northrup, M.A., LBSW West Texas Family and Community Services A project of West Texas A&M University 601 W. 10th Amarillo, Texas 79101 28. Appendix D: Consent Form Consent Form for Participation in: Factors in Womens Breast Health: A Survey of Six Texas Panhandle Counties Date: _________________________ I agree to participate in the research project entitled Factors in Womens Breast Health: A Survey of Six Panhandle Counties. I have read the attached informed consent form, and I understand the possible consequences of participation. I also understand that my participation is strictly voluntary and that I may withdraw my consent at any time. By signing below I certify that I am at least 18 years of age or older. Signed: ___________________________________________________ Printed Name: _______________________________________________ 29. Appendix E: Key Informant Survey (Please mark answers with an X to indicate your responses) 1. Please indicate the current county you live in. A. Carson____ B. Dallam____ C. Gray____ D. Hansford_____ E. Potter____ F. Randall____ 2. What is your date of birth? Month_____ Day ________ Year_________ 3. What is your ethnicity? A. Hispanic/Spanish/Latino E. Asian Indian________ B. White F. American Indian_____ C. Black or African American______ G. Other (Specify) D. Asian or Pacific Islander____ H. Dont Know 4. What is your highest level of education? A. GED____ D. Masters degree____ B. High School Diploma____ E. Ph.D.____ C. Associates degree____ F. None of these____ D. Bachelors degree____ 5. Is it easy for you to access medical services? A. Yes____ B. No_____ (If answered Yes, skip to question 7) 30. 6. If No, why not? (Please check all that apply) A. Transportation___ B. Financial Troubles___ C. No child care_______ D. No support system_____ E. Other____________ 7. Have you ever received information on self-breast exams? A. Yes____ B. No____ 8. Have you ever received information about breast cancer/breast health? A. Yes____ B. No____ (If answered Yes, skip to question 10) 9. If No, why not? (Check all that apply) A. No reason/Never thought about it____ E. Dont know how____ B. Didnt know I needed it______ F. The test is unpleasant______ C. Havent had any problems______ G. Not important____ D. Put it off/Laziness______ 10. Do you have a family history of breast cancer? A. Yes____ B. No_____ 11. How much do you know about breast health/preventative health? 31. A. Nothing at all___ B. Only a little____ C. More than most____ D. A great deal____ 12. Have you ever received information about breast cancer/breast health? A. Yes_____ B. No______ 13. Do you think mammograms are important to your overall health? A. Yes_____ B. No______ 14. Have you ever been/currently diagnosed with any form of cancer? A. Yes_____ B. No______ (If answered No, skip to question 16) 15. If so, which type? A. Lung_____ B. Breast_____ C. Colon_____ D. Rectal _____ E. Prostate_____ 16. Have you ever had a mammogram? A. Yes____ B. No_____ (If answer No, skip to question 18) 17. Have you had a mammogram in the last 12 months? A. Yes______ B. No______ (If answer Yes, skip to question 19) 18. Why not? (Please check all that apply) A. No reason/Never thought about it____ E. Too Expensive/No Insurance____ B. Didnt know I needed it______ F. The test is unpleasant______ C. Havent had any problems______ G. No transportation_______ 32. D. Put it off/Laziness______ H. Other_______________ 19. Do you receive annual clinical exams? A. Yes______ B. No______ (If answered Yes, you are finished with the survey!) 20. Why not? (Please check all that apply) A. No reason/Never thought about it____ E. Too Expensive/No Insurance____ B. Didnt know I needed it______ F. The test is unpleasant______ C. Havent had any problems______ G. No transportation_______ D. Put it off/Laziness______ H. Other______________ THANK YOU FOR YOUR PARTICIPATION. 33. Appendix F: Key Informant Interview Guide Hello, my name is ______________. May I speak with your clinic manager? I am calling with Susan G. Komen for the Cure. We are working on a project to collect information about breast health education and resources in the Texas Panhandle. We are contacting you because you are a clinic manager and we would like to ask if you would be willing to answer a few questions about your clinic that will help us determine our future funding priorities. It is less than 15 minutes long and would provide essential information that will help our community address breast health. Would you be willing to help with our project? The first questions I am going to ask you are about breast health education at your clinic. 1) Where are the women you serve likely to go for breast health information? (You may select more than one option.) (do not read options ) Healthcare providers Community advocacy group Online Printed material such as books or pamphlets Friends/Family Other: Please list ______________________________ 2) Do you provide breast health education materials through your organization? No Yes Unsure 3) Do you serve a non-English speaking population at your site that would benefit from breast health messages and services? No (skip to question 7) Yes 4) Do you provide non-English breast health education materials? No Yes (skip to question 5) Unsure 4a) Do you know where you can access non-English materials if you should need them? No Yes 5) I am going to read you a list of languages that patients in your clinic may speak. For each, please say yes or no to indicate whether your clinic would have a need for breast health education resources in that language. Spanish Yes No Unsure Russian Yes No Unsure Hmong Yes No Unsure Somali Yes No Unsure 34. Other: Please list _____________________? 6) Does your site currently use interpreters to provide breast health education in other languages? No, we are not able to provide interpreters for breast health education in other languages No, we do not have a need for interpreters to provide breast health education Yes, we use interpreters to provide breast health education Unsure 7) I am going to read a list of women that are often targeted for breast health education. Please tell us if your organization targets these populations for breast health education. women 50 years old and older Yes No Unsure 40 to 49 year old women Yes No Unsure 18 to 39 year old women Yes No Unsure Women in racial groups that are at high risk for breast cancer Yes No Unsure Women in ethnic groups that are at high risk for breast cancer Yes No Unsure Everyone gets materials Yes No Unsure 7a) What populations of women come into your clinic that you believe would benefit from being targeted with additional breast health education or screening services? ______________________________________________________________________ _____ ______________________________________________________________________ _____ 7b) I am going to read you a list of types of health care providers. Please respond to each by telling me if that type of provider offers breast health education at your site. Physicians Yes No Unsure Physician assistants Yes No Unsure Masters level prepared nurses Yes No Unsure RNs Yes No Unsure Community health workers Yes No Unsure Other, please specify: _______________________________________________ The next questions I am going to ask relate to screening and diagnostic services that are available at your clinic. 9) Do the providers in your organization provide breast screening and diagnostic tests? No (skip to question 12) Yes Unsure (skip to question 12) 9a) Breast health screenings include mammograms and clinical breast exams. I am going to read you a list of types of health care providers. Please respond to each by telling me if that type of provider offers any breast health screenings at your site. Physicians Yes No Unsure Physician assistants Yes No Unsure Masters level prepared nurses Yes No Unsure RNs Yes No Unsure Radiologists Yes No Unsure Other, please specify: _______________________________________________ 35. 10) Please choose the statement that best describes how your clinic prioritizes breast cancer screening and education? Our clinic addresses breast health at every well woman visit regardless of any other issues that are addressed. We address breast health at well woman visits if there is not a more prominent concern based on the patients medical history. We address breast health at well woman visits only when there is a specific concern about this issue. 11) Does your organization have formal policies that require providers to conduct clinical breast exams on women during their well woman visits? No Yes Unsure 12) Does your organization provide referrals to other clinics if a woman needs breast health screening and education services that are not available at your site? No Yes Unsure 12a) I am going to read a list of barriers that may prevent women from seeking or obtaining breast health services. Please tell me if you perceive the issue to be a barrier for women in your community. Income Yes No Unsure Patients are uninsured Yes No Unsure Patients are under-insured Yes No Unsure Transportation Yes No Unsure Fear Yes No Unsure Other: Please list ___________________ 13) What do you think would help improve the delivery of breast health services in the current healthcare system? ______________________________________________________________________ ________ ______________________________________________________________________ ________ ______________________________________________________________________ ________ 14) Is your clinic able to provide breast cancer screening services to women with disabilities (i.e. mammography capacity for wheelchair bound women)? No Yes Unsure The next few questions ask about how women pay for services at your clinic. 15) I am going to read a list of ways people pay for health services. Please tell me if patients at your clinic use the following method to pay for breast health services. PPO private payer insurance Yes No Unsure HMOs Yes No Unsure Public (govt.) insurance Yes No Unsure 36. Other, please list: _________________________________ 16) Does your site offer any type of financial assistance for uninsured, underinsured or low income clients? No (skip to question 19) Yes Unsure (skip to question 19) 17) Please respond yes or no to indicate whether your site provides each service in the list to income qualifying women. Reduced price mammograms Yes No Unsure Reduced price appointments including clinical breast exams Yes No Unsure Free mammograms Yes No Unsure Free appointments including clinical breast exams Yes No Unsure Referrals to sources that provide free/reduced price mammograms/appointments Yes No Unsure Other, please list: ______________________________________________ 18) What is the income threshold for patients to be eligible for those services? Patients must be Below the federal poverty line Between 100% and 200% of the poverty line Between 200-250% of the poverty line Unsure Other, please list: __________________________________________________ 19) Do you know of other organizations in your community that offer financial assistance to uninsured or under-insured women for breast health services? No (skip to question 20) Yes 19 a) Please list them _______________________________________________ ______________________________________________________________________ __ My final questions today are about partnerships that some organizations are able to form to address breast health needs in the community. 20) Do you presently partner with any other local organizations in providing breast health services to women in your community? No (skip to closing) Yes Unsure (skip to closing) 20a) Please list partnering organizations and describe the partnerships Organization Type of partnership ______________________________________________________________________ _____ ______________________________________________________________________ _____ ______________________________________________________________________ _____ Closing: Thank you for your time and valuable feedback. We greatly appreciate your participation. 37. Appendix G: Survey Scripts The survey introduction serves several purposes: Helps establish the nature of the relationship between the interviewer and the respondent. Establishes a context for the questions and the respondents answers. Establishes credibility. Provides an incentive for the respondent. The incentive is often the feeling the respondent has in cooperating and knowing that their contribution will help lead to a better community. The introduction should include: An introduction to interviewer and organization behind project A statement of purpose A thank you statement An explanation of the importance of respondents input A confidentiality statement and An overview of how data will be used Sample Phone Script Hello, I'm ______ calling on behalf of Susan G Komen for the Cure. We are doing a survey and are asking questions about breast cancer services and your community. The information provided will be used to help Susan G Komen for the Cures local office to create a community profile report which will then inform the work we do in the community. Your name and number was obtained (describe how person/organization was chosen). Because you are a community leader and involved in breast cancer we feel your input is valuable and should be included in our report. Your responses are completely confidential and will only be viewed by the community profile team that is helping us create the community profile report. You don't have to answer any question you don't want to, and you can end the interview at any time. The interview takes about (estimate time). Please feel free to ask any questions you have as we go through the survey and if there is something that I cant answer today, I will provide you the phone number and email address of the contact person at Susan G Komen for the Cure. Begin Scripted Survey Questions Sample In-Person Script 38. Hello, I'm ______ working with Susan G Komen for the Cure on the community profile project. Thank you for meeting with me today to complete this survey on breast cancer in our community. The information you provide will be used to help Susan G Komen for the Cures local office create a community profile report which will then inform the work we do in the community. Your input will help us determine our communitys priorities as they relate to breast cancer and help us determine how our money is best granted, what outreach and advocacy we should be focusing on and in general what areas of focus we need to be aware and involved in. Your name and number was obtained (describe how person/organization was chosen). Because you are a community leader and involved in breast health we feel your input is valuable and should be included in our report. Your responses are completely confidential and will only be viewed by the community profile team that is helping us analyze the data and put together the community profile report. You don't have to answer any question you don't want to, and you can end the interview at any time. The interview should take about (estimate time). Please feel free to ask any questions you have as we go through the survey and if there is something that I cant answer today, I will provide you the phone number and email address of the contact person at Susan G Komen for the Cure. Begin Scripted Survey Questions 39. Appendix H: National and Texas Breast Health, Program, and Service Providers County Provider Address Town Phone # Website Screening Armstrong Coalition of Health Services Inc. 201 S. Park Claude, TX 79019 806-226-5611 Childress Coalition of Health Services, Inc., Fox Rural Clinic Highway 83 North Childress, TX 79201 940-937-9654 Childress Regional Medical Center PO Box 1030 Childress, TX 79201 940-937-6371 Gray Pampa Regional Medical Center 1 Medical Plaza Pampa, TX 79065 806-663-5509 signaturehospital.co m Hutchinson Golden Plains Community Hospital 200 South McGee Borger, TX 79007 806-273-1220 Moore Moore County Hospital District 224 East 2nd St Dumas, TX 79029 806-935-7171 Ochiltree Perryton Health Center/ Ochiltree General Hospital 3101 Garrett Dr. Perryton, TX 79070806-435-7224 Potter/Randall Texas Panhandle Family Planning Health Clinic 1501 S. Taylor Amarillo, TX 79101 806-372-8746 The Don and Sybil Harrington Cancer Center 1500 Wallace Blvd Amarillo, TX 79106 806-356-1905 Harringtoncc.org Women's Healthcare Associates 1301 S. Coulter, suite 300 Amarillo, TX 79106 806-355-6330 Comprehensive Breast Center of the Harrington Cancer Center 1310 Wallace Blvd.Amarillo, TX 79106 806-356-1905 secure.harringtoncc. org Texas Diagnostic Imagine Center 1000 Coulter Amarillo Tx 79106 806-358-1010 Northwest Texas Hospital 1501 South Coulter Rd Amarillo, TX 79106 806-354-1703 Coulter Imaging, LLC 1900 S. Coulter, Suite N Amarillo, TX 79106 806-358-7149 Amarillo Family Physicians Clinic, PA suite 100 South 1215 South CoulterAmarillo, TX 79106 806-354-1703 Amarillo Diagnostic Center 6700 West Ninth Amarillo, TX 79106 806-358-0228 Northwest Women and Children Clinic 814 Martin Rd. Amarillo, TX 79107 806-342-4789 Sherman Stratford Clinic 1220 Purnell PO Box Stratford, TX 79084806-396-2852 Treatment 40. Comprehensive Breast Center 1310 Wallace Blvd.Amarillo, TX 79106 806-356-1905 Texas Diagnostic Imagine Center 1000 Coulter Amarillo Tx 79106 806-358-1010 Education Susan G Komen for the Cure Greater Amarillo Affiliate PO Box 50610 Amarillo TX 79159 806-354-9706 The Don and Sybil Harrington Cancer Center 1500 Wallace Blvd Amarillo, TX 79106 806-356-1905 Harringtoncc.org Comprehensive Breast Center of the Harrington Cancer Center 1310 Wallace Blvd.Amarillo, TX 79106 806-356-1905 Amarillo Area Breast Health Coalition 301 S. Polk St., Suite 740 Amarillo, TX 806-331-4710 aabhc.org/ American Cancer Society 3915 Bell St Amarillo, TX 79109 806-353-4306 cancer.org National Education National Breast Cancer Coalition 800-622-2839 natlbcc.org Women's Cancer Network 312-644-6610 wcn.org Young Survival Coalition 212-916-7667 youngsurvival.org M.D. Anderson Cancer Center 800-345-6324 American Cancer Society 800-227-2345 cancer.org Susan G. Komen for the Cure 877-465-6636 komen.org National Cancer Institute 800-4Cancer Cancer.gov Project Aware project-aware.org Cancer Treatment Centers of America 800-268-0768 Cancer Care 800-813-4673 U.S. Department of Health & Human Services hhs.gov Breast Cancer Network of Strength Medicine World Texas Education Texas Cancer Data Center txcancer.org 41. Texas Department of State Health Services dshs.state.tx.us Texas Cancer Information texascancer.info Texas Department of Health 888-963-7111 tdh.state.tx.us Texas Oncology Mobile Mammograms Hemphill County Hospital 1020 South Fourth Canadian TX 806-323-6422 Clarendon Church of Christ 301 Carhart Clarendon, TX 806-874-2495 Coon Memorial Hospital 1411 Denver Avenue Dalhart, TX 806-246-4571 Medical Center of Dimmitt 300 W. Halsell Dimmitt, TX 806-647-2194 Plains Memorial Hospital 310 West Halsell Box 278 Dimmitt, TX 806-647-2191 ext. 14 Parmer County Hospital1307 Cleveland Friona, TX 806-250-2754 www.pcchtx.com Hereford South Plains Health Provider 110 N. 25 Mile Ave. Suite A Hereford, TX 806-364-7688 Hansford County Hospital 707 S. Roland Spearman, TX 806-659-2535 Swisher Memorial Hospital 539 Southeast Second Tulia, TX 806-995-3581 Parkview Hospital 901 Sweetwater Street Wheeler, TX 806-826-5581 Support Transportation American Cancer Society/ Road to Recovery 3915 Bell St Amarillo, TX 79109 877-227-1618 www.cancer.org Panhandle Community Services- Panhandle Transit 1309 W. 8th Amarillo, TX 79120 806-372-2531 Medicaid Transportation 877-633-8747 Jan Werner Transit 3108 S Fillmore Amarillo, TX 79110 806-374-5516 Housing Ronald McDonald House of Amarillo 1501 Streit Amarillo, TX 806-358-8177 Circle of Friends Apartments American Cancer Society 3915 Bell St Amarillo, TX 79109 806- 353-4306 www.cancer.org Support Groups 42. The Don and Sybil Harrington Cancer Center 1500 Wallace Blvd Amarillo, TX 79106 806-356-1905 www.Harringtoncc.or g Pathways On-going support group Journeys 2nd Monday of each month 5:30-7:00 PM Amphitheater, 2nd floor Women in Touch 3rd Monday of each month 5:30-7:00 PM Amphitheater, 2nd floor Dialogue Thursdays noon-1:00 PM Amphitheater, 2nd floor Radiation Therapy Class Tuesdays 9:00-11:30 AM Pampa Area Cancer Support Group 100 W 30th Ave Pampa, TX 79065 806- 663-5566 www.prmctx.com 4th Tuesday 6:00 PM Pampa Regional Medical Center Cafeteria Hereford Regional Medical Center 801 E. 3rd St Hereford, TX 79045806-364-2141 2nd Monday of each month 6:30-7:30 806-364-2121 ext 3370 Breast Cancer Support www.Bcsupport.org Network of Strength 2BME www.2bme.org Anderson Network 800-345-6324 www.mdanderson.or g Medicine World Texas Oncology Susan G. Komen www.komen.org Mastectomy Products Advanced Limb and Brace 1900 S Coulter St # E Amarillo, TX 79106 806-351-1775 The Woman's Personal Health Resource Inc. 877-463-1343 Breast Forms 800-734-1886 www.Breastform.co m Nearly You Mastectomy Products 866-722-6168 www.nearlyyou.com Tender Loving Care 800-850-9445 www.tlcdirect.org Me Again Breast Prosthesis Boutique Amarillo, TX 806-358-7851 Wigs Feke Wigs www.fekewings.com Best Wig Outlet www.bestoutlet.com Hairpieces for Women www.headcovers.co m Affordable Wigs 1201 Buchanan Street Amarillo TX 79107 806-372-3541 Evilene's Wigs & Accessories 3701 Plains Blvd Amarillo TX 79102 806-331-4247 43. G-Bob's Wigs 3801 Olsen Blvd Amarillo TX 79109 806-352-1601 Merle Norman Cosmetics 3440 Bell St. Amarillo, TX 79109 806-352-1022 American Cancer Society 3915 Bell St Amarillo, TX 79109 877-227-1618 www.cancer.org Hair Club for Men & Women 6900 West Interstate 40 Amarillo, TX 79106 806-353-4247 Financial Assistance AVONCares Program for Medically Underserved Women 800-813-4673 www.cancercare.org National Cancer Institute www.cancer.gov Coverage for All- Healthcare Coverage 800-234-1317 www.coverageforall. org University Medical Center 806-775-9045 Medicaid Hotline 800-422-6237 www.cms.hhs.gov Medicare Hotline 800-633-4227 Patient's Advocate Foundation's Co-Pay Relief Program 866-512-3861 Health Well Foundation Financial Assistance 800-675-8416 Partnership for Prescription Assistance 888-477-2669 www.pparx.org Prescription Assistance for Drug Companies Abbott Laboratories Prescription Assistance 800-444-4106 www.abbott.com Astra Zeneca Prescription Assistance 800-292-6363 www.astrazeneca.co m Aventis Sanofi-Aventis Prescription Assistance 888-477-2669 www.sanofi- aventis.us Bayer Prescription Assistance 800-998-9180 www.bayer.com Biogen Idec Prescription Assistance 800-456-2255 Boehringer Ingelheim Prescription Assistance 800-556-8317 Bristol-Meyers Squibb Prescription Assistance 212-546-4000 www.bms.com Forest Laboratories Prescription Assistance 800-951-0758 www.frx.com Glaxo Smith Prescription Assistance 866-475-3678 www.gsk.com Glaxo Smith Kline 888-825-5249 www.gsk.com 44. King Pharmaceuticals Prescription Assistance 866-734-7366 www.kingfarm.com Lilly Prescription Assistance 800-545-6962 www.lilly.com Merck Prescription Assistance 800-727-5400 www.merck.com Novartis Prescription Assistance 862-778-8300 www.novartis.com Partnership for Prescription Assistance 888-477-2669 www.pparx.com Pfizer Prescription Assistance 212-733-2323 www.pfizer.com Roche Prescription Assistance 877-757-6243 www.roche.com Sanofi-Aventis Prescription Assistance 908-981-5000 www.sanofi- aventis.us Schering Plough Prescription Assistance 800-521-7157 Solvoy Pharmaceuticals 800-256-8918 Teva Pharmaceuticals Prescription Assistance 877-254-1039 www.rx-med.net Watson Prescription Assistance 800-964-4766 www.nextag.com Wyeth Prescription Assistance 800-568-9938 www.wyeth.com Hospitals Potter Baptist St. Anthony's 1600 Wallace Blvd Amarillo, TX 79106 806-212-2000 www.bsahs.org Potter Northwest Texas Healthcare System 1501 South Coulter Rd Amarillo, TX 79106 806-354-1703 Hutchinson Golden Plains Community Hospital 200 South McGee Borger, TX 79007 806-273-1220 www.goldenplains.or g Hemphill Hemphill County Hospital 1020 S. 4th St. Canadian, Tx 79014806-323-6422 www.hch.dst.us.us Randall Palo Duro Hospital 2 Hospital Dr. Canyon, TX 79015 806-655-7751 Childress Childress Regional Medical Center PO Box 1030 Childress, TX 79201 940-937-6371 Dallam Coon Memorial Hospital 1411 Denver Ave. Dalhart, TX 79022 806-249-4571 Castro Castro County Healthcare Plains Memorial Hospital 310 W. Halsell St. Dimmitt, TX 79027 806-647-2191 Moore Moore County Hospital 224 E. 2nd St. Dumas, TX 79029 806-935-7171 Parmer Parmer County Community Hospital 1307 Cleveland Ave Friona, TX 806-250-2754 www.pcchtx.com Deaf Smith Hereford Regional Medical Hospital 801 E. 3rd St. Hereford TX 79045 806-364-2141 Gray Pampa Regional Medical Center 1 Medical Pl Pampa, TX 79065 806-665-3721 www.prmctx.com 45. Ochiltree Ochiltree General Hospital 3101 Garret Dr. Perryton, TX 79070806-435-3606 Hansford Hansford County Hospital 707 Roland St. Spearman, TX 79081 806-659-2535 www.hchd.net Collingsworth Collingsworth General Hospital 1014 15th St. Wellington, TX 79095 806-447-2521 Wheeler Parkview Hospital 1000 Sweetwater St Wheeler, TX 79096 806-826-3201 www.parkviewhosp.o rg