Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery

Abstract Background Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialt...

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Autores principales:	Tuya Pal, Pamela C. Hull, Tatsuki Koyama, Phillip Lammers, Denise Martinez, Jacob McArthy, Emma Schremp, Ann Tezak, Anne Washburn, Jennifer G. Whisenant, Debra L. Friedman
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Virtual molecular tumor board Consolidated framework for implementation research (CFIR) Precision medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
Acceso en línea:	https://doaj.org/article/c96d71d97bce4e38a0b3a19b9e420c10
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spelling	oai:doaj.org-article:c96d71d97bce4e38a0b3a19b9e420c102021-11-28T12:27:24ZEnhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery10.1186/s12885-021-08949-41471-2407https://doaj.org/article/c96d71d97bce4e38a0b3a19b9e420c102021-11-01T00:00:00Zhttps://doi.org/10.1186/s12885-021-08949-4https://doaj.org/toc/1471-2407Abstract Background Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. Methods Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. Discussion The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. Trial registration Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 – Retrospectively registered, http://www.clinicaltrials.gov/Tuya PalPamela C. HullTatsuki KoyamaPhillip LammersDenise MartinezJacob McArthyEmma SchrempAnn TezakAnne WashburnJennifer G. WhisenantDebra L. FriedmanBMCarticleVirtual molecular tumor boardConsolidated framework for implementation research (CFIR)Precision medicineNeoplasms. Tumors. Oncology. Including cancer and carcinogensRC254-282ENBMC Cancer, Vol 21, Iss 1, Pp 1-11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Virtual molecular tumor board Consolidated framework for implementation research (CFIR) Precision medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282
spellingShingle	Virtual molecular tumor board Consolidated framework for implementation research (CFIR) Precision medicine Neoplasms. Tumors. Oncology. Including cancer and carcinogens RC254-282 Tuya Pal Pamela C. Hull Tatsuki Koyama Phillip Lammers Denise Martinez Jacob McArthy Emma Schremp Ann Tezak Anne Washburn Jennifer G. Whisenant Debra L. Friedman Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
description	Abstract Background Despite lower cancer incidence rates, cancer mortality is higher among rural compared to urban dwellers. Patient, provider, and institutional level factors contribute to these disparities. The overarching objective of this study is to leverage the multidisciplinary, multispecialty oncology team from an academic cancer center in order to provide comprehensive cancer care at both the patient and provider levels in rural healthcare centers. Our specific aims are to: 1) evaluate the clinical effectiveness of a multi-level telehealth-based intervention consisting of provider access to molecular tumor board expertise along with patient access to a supportive care intervention to improve cancer care delivery; and 2) identify the facilitators and barriers to future larger scale dissemination and implementation of the multi-level intervention. Methods Coordinated by a National Cancer Institute-designated comprehensive cancer center, this study will include providers and patients across several clinics in two large healthcare systems serving rural communities. Using a telehealth-based molecular tumor board, sequencing results are reviewed, predictive and prognostic markers are discussed, and treatment plans are formulated between expert oncologists and rural providers. Simultaneously, the rural patients will be randomized to receive an evidence-based 6-week self-management supportive care program, Cancer Thriving and Surviving, versus an education attention control. Primary outcomes will be provider uptake of the molecular tumor board recommendation and patient treatment adherence. A mixed methods approach guided by the Consolidated Framework for Implementation Research that combines qualitative key informant interviews and quantitative surveys will be collected from both the patient and provider in order to identify facilitators and barriers to implementing the multi-level intervention. Discussion The proposed study will leverage information technology-enabled, team-based care delivery models in order to deliver comprehensive, coordinated, and high-quality cancer care to rural and/or underserved populations. Simultaneous attention to institutional, provider, and patient level barriers to quality care will afford the opportunity for us to broadly share oncology expertise and develop dissemination and implementation strategies that will enhance the cancer care delivered to patients residing within underserved rural communities. Trial registration Clinicaltrials.gov , NCT04758338 . Registered 17 February 2021 – Retrospectively registered, http://www.clinicaltrials.gov/
format	article
author	Tuya Pal Pamela C. Hull Tatsuki Koyama Phillip Lammers Denise Martinez Jacob McArthy Emma Schremp Ann Tezak Anne Washburn Jennifer G. Whisenant Debra L. Friedman
author_facet	Tuya Pal Pamela C. Hull Tatsuki Koyama Phillip Lammers Denise Martinez Jacob McArthy Emma Schremp Ann Tezak Anne Washburn Jennifer G. Whisenant Debra L. Friedman
author_sort	Tuya Pal
title	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
title_short	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
title_full	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
title_fullStr	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
title_full_unstemmed	Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
title_sort	enhancing cancer care of rural dwellers through telehealth and engagement (encore): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery
publisher	BMC
publishDate	2021
url	https://doaj.org/article/c96d71d97bce4e38a0b3a19b9e420c10
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Enhancing Cancer care of rural dwellers through telehealth and engagement (ENCORE): protocol to evaluate effectiveness of a multi-level telehealth-based intervention to improve rural cancer care delivery

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