Development of an electronic tool to improve access to cancer clinical trials in rural areas

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This is a resubmission application for a K01 AHRQ Mentored Research Scientist Career Development Award. I am a faculty junior researcher at the University of Hawaii Cancer Center who is currently supported by an AHRQ- sponsored F32 National Research Service Award Postdoctoral Fellowship (1F32HS027286-01A1). My long-term research career goal is to develop into an independent health services researcher focused on improving rural cancer healthcare delivery. The protected time supported by this four-year award will allow me to acquire new skills and develop expertise in healthcare delivery interventions and has the following main goals: 1) obtain training in the development and testing of healthcare delivery interventions, interventional clinical trials, and implementation science, and 2) professional development. To achieve these goals, I have established a mentoring team comprised of a senior investigator in cancer clinical research (Dr. Berenberg, primary mentor), a nationally recognized expert in interventional trials (Dr. Hershman), a national leader in cancer health services research (Dr. Holcombe), and faculty with expertise in behavioral intervention (Dr. Cassel) and implementation science (Dr. Okamoto). These mentors and two consulting members will provide guidance on the proposed training and research activities designed to facilitate my transition from a junior researcher to an independent health services researcher. Although advances in treatment have improved overall survival of patients with cancer, death rates from all cancers among rural residents in the United States are 10% higher than those living in urban areas. Higher cancer mortality rates in rural areas are thought to, in part, reflect limited access to specialty cancer care. A potential strategy to reduce these disparities is to increase access to high-quality cancer clinical trial care in rural areas; however, there are numerous barriers to clinical trial enrollment in rural areas. To address these barriers, in collaboration with my mentoring team, I will develop and pilot test CTNow, a multi- component, multilevel interactive electronic tool that combines patient and provider cancer clinical trial education and a real-time videoconference system that enables rural patients and providers to access a clinical trial team for consultation, referral, and clinical trial enrollment. The proposed research has the following aims: 1) conduct a formative mixed-methods evaluation with rural oncology providers and patients to assess capabilities and the contextual factors of the rural intervention settings, 2) develop and pilot test CTNow for rural patients and providers, and 3) identify remaining barriers and facilitators to rural clinical trial participation and strategies to support future implementation of CTNow. My training and research will be conducted at one of the 71 National Cancer Institute-designated cancer centers with a well-established program in cancer care delivery research. During years 3 and 4, I will develop and submit an R01 application to propose a multi-site, hybrid effectiveness- implementation study conducted through rural NCORP sites. My current and future research aims are closely aligned with AHRQ’s mission to improve health care delivery in a high priority population residing in rural areas.