What to know
Consider the needs and opportunities in your community when planning your program.
Background
CDC selected four National Comprehensive Cancer Control Program award recipients for a pilot project on bridging the health equity gap experienced by people with cancer in rural communities. This practice guide highlights four keys to success that health practitioners can use.
Strategy
Project ECHO (Extension for Community Healthcare Outcomes) and patient navigation programs are flexible interventions that work best when customized to the community's needs and resources. Each pilot site considered its unique circumstances, needs, challenges, and opportunities to achieve quality, impact, and efficiency when shaping its interventions.
Montana
The Montana Department of Public Health and Human Services presented a flexible model for patient navigation that could be tailored to each clinic.
"We realized the patient navigation role would need to be unlicensed because many [federally qualified health centers] use [community health workers] for resource and enabling services. We defined the role a little more precisely and presented it to the clinics because it was a great way to roll out cancer survivorship resource services into existing services." [Montana]
Montana had trouble identifying people with cancer from its electronic medical records, so staff worked with the state Medicaid program to identify patients who had a clinic visit within the previous year. This list was sent securely to navigators, who then reached out to offer their services.
"Now that we identified at least some survivors, presented to the providers, and got them on board with the clinics, they want us to present to the nursing staff so they can start referring as they identify cancer survivors. We're also doing outreach with posters and social media content to see what that brings in through community involvement." [Montana]
South Carolina
The South Carolina Department of Health and Environmental Control initially planned to join an established ECHO hub but did not find one aligned with its goals and timeline. Undaunted, the state shifted gears to create a new ECHO hub.
"Our initial approach was to join an established ECHO hub, but when we found that wasn't feasible for the timeline or the resources we had available, our approach was to become a separate Project ECHO site. I think it was advantageous for us to learn the model." [South Carolina]
Insights from pilot sites
- Understand and consider the needs and opportunities in your community when planning your program. For example, federally qualified health centers are well-connected with community resources and in-house referral programs. They may offer a good model for wraparound services in other rural practices.
- Provide culturally competent navigation services. Use program supports that align with providers' and participants' cultural norms, beliefs, and practices. Rural health care providers have earned their patients' trust, so engage them when guiding people with cancer to needed resources.
- Create new infrastructure when necessary. Building programs on the foundation of existing resources can be highly efficient when goals are well aligned, but when goals do not match, create something new to achieve your goals.
- Link people with cancer to resources to remove barriers to participation and promote inclusiveness.