Expanding Rural Access: Distance Delivery of Support Groups

Institution: Stanford University
Investigator(s): Cheryl Koopman, Ph.D. - Mary Anne Kreshka, M.A. - Susan Ferrier, R.N. -
Award Cycle: 2004 (Cycle 10) Grant #: 10AB-2801 Award: $62,656
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

This is a collaboration with: 10AB-2800 -

Initial Award Abstract (2004)
Women with breast cancer living in rural areas have less access to psychosocial support than their urban counterparts due to geographic distances from sources of support, inclement weather, and confidentiality concerns in small communities. Videoconferencing can be used to increase access to psychosocial support for women with breast cancer.

Northern Sierra Rural Health Network (NSRHN) is collaborating with Stanford University School of Medicine to determine whether the technology resources already in place can be used to expand access to support services for women living with breast cancer. The study has three primary aims:
Aim 1: Determine the feasibility and acceptability of using an existing videoconferencing network to reduce rural/urban inequities in access to psychosocial support for women with breast cancer residing in rural northeastern California.
Aim 2: To evaluate whether the psychosocial support needs of women with breast cancer living in rural northeastern California, as they are understood by the women themselves, can be met through the use of videoconferencing
Aim 3: Support the capacity of the communities in the target region to use videoconferencing to improve access to psychosocial support for women with breast cancer.

We plan to recruit 40 rural women living with breast cancer from Plumas, Modoc, and Siskiyou Counties for the research. Each participant will provide informed consent, complete baseline assessments on validated quality of life measures, participate in 8 weekly support groups conducted by vide conferencing and complete a follow-up assessment that will include a brief interview to elicit feedback about the intervention and the mode of delivery.

This research has the potential to inform the design and implementation of technology-based intervention that would be readily accessible to rural women with breast cancer. This would tap the potential of technology that is already in use in the nine rural counties served by NSRHN for providing psychosocial support. Our future plans are to disseminate the findings and train health care providers with the hope of establishing one or more types of psychosocial support delivered via videoconferencing as part of routine care for rural women with breast cancer on a continuous basis.


Final Report (2005)
Our community-based project explored the use of an existing videoconferencing network to increase access to leader-led support groups for women living with breast cancer in rural communities of northeastern California. This involved a collaboration between Northern Sierra Rural Health Network (NSRHN) and Stanford University School of Medicine to determine whether the video-conferencing technology resources already in place can be used to expand access to support for women living with breast cancer.

Twenty-seven women with breast cancer living in rural northeastern California participated in a pilot study to test the feasibility of using videoconferencing, augmented with a workbook journal, to provide professionally-led support groups across a distance. Altogether four groups were conducted. Each woman participated in an 8-session support group that was based on the Supportive-Expressive model of group support and was led by an experienced oncology social worker. Up to four videoconferencing sites were connected for each support group so participants could interact with each other and the facilitator.

This study found that it was feasible and acceptable to use an existing videoconferencing network to provide greater access to psychosocial support for women with breast cancer who live in northeastern California. Group attendance was excellent and satisfaction ratings were high. Older as well as younger women were comfortable using this modality. Participants reported that the groups were beneficial in facilitating informational support and promoting emotional bonds with other women with breast cancer. They endorsed the importance of having a professional facilitator, and they identified advantages of using videoconferencing. Significant decreases in depression and posttraumatic stress disorder symptoms were found at posttest. The results suggest that the intervention has the potential to provide a valuable service that is not readily available in rural communities.

Our future plans include continuing to contribute to knowledge about the use of videoconferencing to provide greater access to support services for women living with breast cancer in rural communities. Our partnership is currently scheduled to provide consultation to the Southwest Georgia Cancer Coalition to address its interest in pilot testing the provision of support groups via videoconferencing. We are also interested in conducting a larger randomized trial to further build upon the findings of this pilot study.