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: 2016 (Cycle 22) Grant #: 22AB-1300 Award: $76,487
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: 22AB-1301 -

Initial Award Abstract (2016)

Introduction: This pilot study 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. Residents of Modoc and Plumas have no access to mammograms, major surgery, cancer treatment services and must travel out of county/state for services (5-6 hours roundtrip). This project supports data from several previous CRC projects and input gathered by the Community-Research team over the past 3 years identifying a strong need for access to breast cancer information and support I n rural/frontier communities, and mortality disparities among rural patients, and preference and support for trained peer counselors. Thus, we aim to test the feasibility and acceptability of using telehealth technology to empower rural breast cancer survivors as “telenavigators”, who would provide a tailored cognitive behavioral stress management (CBSM) program to rural breast cancer survivors (RBCS) within their own communities.

Question(s) or hypotheses: Is it feasible to recruit and train rural/frontier peer telenavigators to increase access to needed support and resources for RBCS? General methodology: We will use formative research methodology to gather data to:

  1. Develop a peer telenavigator pilot intervention to provide support (addressing emotional, instrumental, positive social interactions, empowerment in problem-solving and coping) and increase access to informational resources for underserved and isolated rural women with breast cancer.
  2. Evaluate the feasibility and acceptability of a peer-delivered CBSM model using telehealth to improve access to breast cancer information and support in rural communities.
  3. Strengthen the community-research partnership and build each otherís capacity to address rural health disparities.

To address Aim 1, our Community-Research team will obtain input from key stakeholders from the 3 rural northeastern California counties towards the adaptation an existing CBSM intervention, tailored specifically to RBCS. To address Aim 2, we will train 6 RBCS as peer telenavigators to implement the intervention via use of video-based conferencing technology. We will then recruit 12 RBCS who will be matched to a peer telenavigator based on county of residence. Pre- and post-intervention surveys will be conducted at baseline, 8, and 12 weeks (4 weeks post-intervention) with telenavigators and RBCS to assess feasibility and acceptability, as well as changes in key outcomes, including quality of life and breast cancer concerns, social support, and stress management and coping.

Innovative elements: Technology will be used to overcome distance barriers in this 7,429 sq mile region that includes three mountain ranges: The Sierra Nevada, Cascade Range and Warner Mountains. The 6 telenavigators will receive tablet notebooks and data connectivity, in addition to technical training for using these technologies and support throughout the intervention. The project will use the internet, interactive high definition, HIPAA-compliant videoconferencing, and data sharing software to connect the telenavigators and patients in their homes.

Community involvement: This project is in response to the community partnersí 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 involvement includes the community Investigators, the Community Advisory Board comprised of representatives of the three counties, the telenavigators, and community project patients.

Future plans: Our teamís future plan is to pursue a CRC Full Research Award to test the effective of the telenavigator model in a larger geographic region, making modifications as needed based on results of the pilot study.

1 Rural Assistance Center, Definition of Rural