Women in Survivorship Healthcare (WISH): Implementation of a Nurse Navigation Model for Medically Underserved Breast and Gynecologic Cancer Survivors using Project ECHO

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Project Summary/Abstract There are currently over 15 million cancer survivors in the US and this number is expected to exceed 20 million by 2026 due to population aging and growth. In 2006, the Institute of Medicine (IOM) released a landmark report outlining recommendations, including use of a survivorship care plan (SCP) to address the needs of cancer survivors, and other organizations have issued guidelines to improve survivorship care. Despite this recognition, research clearly documents the persistence of unmet needs among cancer survivors including less than optimal preventive and cancer surveillance screening rates. Several barriers have been identified in the effort to achieve optimal survivorship care: the current health care system is fragmented, difficult to navigate and communication between oncologists and primary care providers is often minimal. Further, a predicted shortage of oncologists/oncology services in relation to increases in cancer survivors highlights the need for alternative solutions. These circumstances underscore the urgent need to develop more effective models of care integration. The IOM, American Cancer Society and the American Society of Clinical Oncology all emphasize the importance of enhancing the role of primary care providers (PCPs)–general practice, family practice, obstetrics and gynecology, geriatrics, and internal medicine–in survivorship care. The use of SCPs is increasingly common, yet research has demonstrated implementation barriers that limit their effectiveness. Despite research aimed at implementing integrated care models, systematic reviews conclude that no standard of care exists for survivorship models. Encouragingly, studies have shown no differences in adverse outcomes of patients cared for by PCPs as compared to oncologists for certain cancer types. Prior research conducted by members of our research team, which serves as the basis for this proposal, found that both PCPs and patients are willing to participate in a survivorship care model. New Mexico, a large, rural, minority- majority state, with deep socioeconomic disparities that limit access to care, presents an ideal environment to advance implementation of SCPs in a broader integrated care model. In order to systematically develop and implement a survivorship care model, we have convened a partnership between community-based primary care providers, researchers and clinicians in the University of New Mexico Comprehensive Cancer Center (UNMCCC) and Departments of Family and Community Medicine, Obstetrics and Gynecology, and Project ECHO (Extension for Community Healthcare Outcomes), an innovative telementoring platform. The overall objective of the ECHO Women in Survivorship for Health (WISH) study is to implement and assess a survivorship care model by training a network of primary care providers through Project ECHO and then transitioning patients through nurse navigation and coordinated follow-up with a multidisciplinary specialist care team at the UNMCCC.