Using Telenavigators to Support Rural Breast Cancer Patients

Institution: Cancer Prevention Institute of California
Investigator(s): Scarlett Gomez, PhD - Susan Ferrier, R.N. -
Award Cycle: 2015 (Cycle 21) Grant #: 21AB-1100 Award: $14,900
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Health Policy and Health Services: better serving women's needs



Initial Award Abstract (2015)

Introduction: Our proposed research addresses breast cancer survivorship disparities in California’s rural communities, focusing on 3 designated rural/frontier northern California counties: frontier Modoc and Plumas Counties and rural Nevada County. Frontier is defined as “the most rural settled places along the rural-urban continuum, with residents far from health care, schools, grocery stores, and other necessities. Frontier areas face challenges in providing access to health and human services even greater than the challenges faced by less isolated rural communities.”1 Relative to the average California county, which has 239 people/sq mile, Modoc County has 2.5 persons/sq mile over 3,918 miles, Plumas has 7.8 people/sq miles over 2,553 miles, and rural Nevada County has 103 people/sq mile over 958 miles. Our research follows up on data from several previous CRC projects and input gathered by the Community-Research team over the past 2 years identifying a strong need for access to breast cancer information and support in rural/frontier communities, and mortality disparities among rural patients. Ultimately, we aim to test the feasibility and acceptability of using telehealth technology to empower rural breast cancer survivors as “telenavigators”, who would provide peer-delivered navigator services in response to the stated needs of the community. This Planning Grant will be used to support the further development and strengthening of our proposal to develop and test a telenavigator model that leverages telehealth technology and uses local breast cancer peer navigators to deliver access to informational and support resources and promote empowerment in problem-solving and coping in rural communities.

General methodology: We propose a 6-month planning period focused on improving our CRC pilot grant application by revising the application according to the Review Committee’s critiques. During the 6-month period, we will plan to submit the application for the CBCRP pre-review, and target the March 2016 CRC application submission date. Specifically, we will focus our specific Planning Grant activities on:
1. Better organization of research plan to clarify overall flow and description of each phase and associated inclusion criteria and approaches, and demonstrate feasibility.
2. Better integration with Precede-Proceed framework by more explicitly describing framework, where the currently proposed research fits in, and how the framework helps to guide future research informed by the current research.
3. Describing how we will identify and address distress in patients.
4. Discussing the applicability of the Neuvo Amanacer program for rural white non-Latino patients.
5. Discuss the engagement of nursing students in the pilot project.
6. Expand upon the “Potential limitations and strengths” section by addressing issues raised by Reviewers that would be infeasible to include in the pilot project, such as: matching on disease spectrum, including more patients, etc.

Community involvement: This project is in response to the community partners’ ongoing collaboration with the designated communities to increase access to specialty care through telehealth. The services identified in this pilot were identified by the communities. Community partners from rural community-based organizations, breast cancer patients, and key stakeholders in rural communities will be involved in the Planning Grant, including informing the applicability of the Neuvo Amanacer program that we aim to adapt to rural patients, and to address concerns regarding the identification and management of distress among navigated patients.

Future plans: This Planning Grant will provide the necessary preliminary data and protected time to strength our CRC Pilot Grant. Our ultimate goal is to pursue a larger study through the CRC Full Research Award to test the dissemination and effectiveness of this intervention. As we envision that the innovative delivery of support services by telenavigators has tremendous potential for impact beyond the rural community, we will also pursue applications to test its effectiveness in other isolated communities.

1 Rural Assistance Center, Definition of Rural, http://www.raconline.org/topics/frontier.




Final Report (2016)

Our goal is to leverage telehealth technology to overcome barriers to accessing breast cancer support and resources in geographically isolated rural California communities. Geographic isolation is a major barrier limiting access to healthcare, and other resources, leading to a lack of empowerment and social support, feelings of disconnection from available resources, low quality of life, and ultimately mortality disparities. Using telehealth systems to achieve this goal is an innovative and promising strategy to reach underserved and isolated rural communities. Based on community input gathered by our Community-Research team over the past several years, we identified a strong need for providing more efficient and effective access to breast cancer information and social support in rural communities. Telehealth and peer navigation are each well-established, but the extent to which they can work together and are acceptable and feasible for rural breast cancer survivors (RBCS) is unknown. Thus, our immediate goal is to investigate the use of telenavigators to bridge access to an evidence-based, peer-delivered navigation program for isolated RBCS. Our long-term research goal is to use telehealth to improve health-related quality of life, access to informational and support resources, and empowerment in problem-solving and coping, and ultimately mitigate the higher mortality among rural breast cancer patients.

We used the 6-month Planning Grant to improve our CRC grant application by revising the application according to the Review Committee’s critiques, and gathering preliminary data in support of the application. Specifically, over this Planning Grant period, our team focused on:


1. Better organization of research plan to clarify overall flow and description of each phase and associated inclusion criteria and approaches, and demonstrate feasibility.
2. Better integration with Precede-Proceed framework by more explicitly describing framework, where the currently proposed research fits in, and how the framework helps to guide future research informed by the current research.
3. Describing how we will identify and address distress in patients.
4. Better description of the Neuvo Amanacer program, and discussing the applicability of the Neuvo Amanacer program for rural primarily white non-Latino patients.
5. Expand upon the “Potential limitations and strengths” section by addressing issues raised by Reviewers that would be infeasible to include in the pilot project, such as: matching on disease spectrum, including more patients, etc.

In particular, Ms. Ferrier and Ms. Kreshka traveled to Modoc and Plumas and collected further community feedback in support of the feasibility of the proposal.

The team met every other week in the first 3 months, then monthly, to discuss specific plans for improving the grant application, and to review and provide feedback on the application.

We submitted a grant for CBCRP pre-review in October 2015 and submitted the CRC Pilot grant in March 2016. Thus, we met our goals for this Planning Grant. We did not encounter any barriers to completing this work.