Pairing Project ECHO and patient navigation as an innovative approach to improving the health and wellness of cancer survivors in rural settings

Abstract

Purpose: We conducted a 12-month pilot study of 2 complementary strategies for improving rural cancer survivorship outcomes: (1) Project ECHO, a telementoring model to increase knowledge and skills about cancer survivorship among multidisciplinary health care provider teams in rural areas and (2) patient navigation (PN) services to connect rural cancer survivors with resources for enhancing health and wellness. Methods: We recruited 4 CDC-funded National Comprehensive Cancer Control Program sites to implement Project ECHO and PN interventions for a defined rural population in each of their jurisdictions. Sites received ongoing technical assistance and a stipend to support implementation. We conducted a mixed-methods evaluation consisting of quantitative performance monitoring data and qualitative interviews with site staff to assess implementation.Findings: Site teams delivered 21 cancer survivorship ECHO sessions to rural providers resulting in 329 participant encounters. Almost all (93%) ECHO participants reported enhanced knowledge of cancer survivorship issues, and 80% reported intent to apply learnings to their practices. Site teams engaged 16 patient navigators who navigated 164 cancer survivors during the study period. Successful implementation required strong partnerships, clear avenues for recruitment of rural providers and cancer survivors, and activities tailored to local needs. Fostering ongoing relationships among sites through community of practice calls also enhanced implementation.

Barriers, facilitators, and priority needs related to cancer prevention, control, and research in rural, persistent poverty areas

“…Cancer navigators were identified as facilitators of cancer prevention and control activities, reflecting the increasing recognition of patient navigation as a key element in high-quality, patient-centered cancer care. This is consistent with prior literature which documents the value of cancer navigators in cancer prevention and survivorship care, as well as in rural settings, communities living in poverty, and other underserved communities [ 31 – 36 ]. Clinic providers and staff also identified community health events and services as a facilitator, which is consistent with prior literature demonstrating the efficacy of a range of community-based cancer outreach and screening interventions [ 37 – 41 ].…”

Use of Cancer Survivorship Care Guidelines by Primary Care Providers in the United States

“…32,33 As well, patient navigators or community health workers (CHWs) can help patients make follow up appointments, obtain transportation, and overcome other barriers to care. 34,35 Other team-based approaches that integrate PCPs into the oncology care team using scalable, less resource intensive methods may be another promising approach. 36 Health information technology might help support PCPs in providing survivorship care.…”

“…In these areas, PCPs may often be the main point of contact for survivors, rather than an oncologist. Specific areas the NCCCP has shown may be helpful are equipping PCPs with advanced skills in managing cancer survivors in their caseloads through participation in Project ECHO and other types of learning collaboratives, 34 and increasing knowledge through an online e-learning series on cancer survivorship care topics. 45 This study had several notable limitations and strengths.…”

Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers

“…5 CHWs have been proposed or utilized in rural and underresourced settings to target a variety of health outcomes, including cardiovascular dis ease, 6 cancer screening 79 and cancer survivorship. 10 It is unclear how rural and underresourced primary care clinics are utilizing CHWs and what barriers may preclude more widespread use of CHWs to address SDoH. The recent COVID19 pandemic disproportionately affected rural and underresourced urban areas and demonstrated how diseases impact individuals without critical social resources and support.…”

“… 5 CHWs have been proposed or utilized in rural and under-resourced settings to target a variety of health outcomes, including cardiovascular disease, 6 cancer screening 7 - 9 and cancer survivorship. 10 …”