Enhancing Cancer Care Of Rural Dwellers Through Telehealth and Engagement (ENCORE)

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The proposed project is submitted in response to RFA-CA-18-026, providing an “IT-enabled, team-based care delivery models … to deliver comprehensive, coordinated, high-quality cancer-related care to rural low-income and/or underserved populations.” There are widening mortality disparities among rural cancer patients, particularly those who live in counties with persistent poverty, making it critical to develop interventions to improve outcomes for these patients. Therefore, the proposed study is based at seven rural hospitals in Tennessee and Mississippi, states with large rural populations encompassing a third and a half of the population, respectively. With barriers at the health system, provider and patient level, multi-level remotely-delivered interventions that enable rural patients and providers to access expertise housed at a comprehensive cancer center hold tremendous promise. Through the proposed study, we will employ a Type 1 Hybrid Effectiveness-Implementation design, which includes a traditional clinical effectiveness trial along with a process evaluation of the intervention delivery and implementation. Specifically, we will evaluate the 1) clinical effectiveness of a multi-level telehealthbased intervention for rural hospitals consisting of provider-level access to a molecular tumor board and patientlevel access to supportive care; and 2) facilitators and barriers to future larger scale dissemination and implementation of this multilevel intervention, designed to enhance quality of rural cancer care delivery. The intervention consists of non-randomized provider-level access to a tumor board which incorporates disease, patient and molecular tumor characteristics to enhance treatment options, together with randomized patient-level access to a self-management intervention versus attention control. The Consolidated Framework for Implementation Research will be used to identify barriers and facilitators. These efforts are possible due to existing community partnerships already in place, which will be leveraged to bring comprehensive care available at our cancer center to rural cancer patients and providers through telehealth. To further underscore the importance of our efforts, the Southern United States in which our academic cancer center is based has amongst the highest cancer mortality rates, and is the region of focus for this application. Our short-term goals are to explore means by which to enhance cancer care among rural cancer patients through broadly and remotely sharing expertise available at our cancer center with rural underserved communities in our region. Our long-term goals are to disseminate evidence-based strategies to improve outcomes among rural cancer patients.