CCSG Supplement: Assessing Facilitators and Barriers to Implementation of the National Survivorship Care Standards in Rural Health Systems

PROJECT SUMMARY/ABSTRACT This application s being submitted in response to the Notice of Special Interest (NOSI) identified as NOT-CA-24-041. There are more than 18 million cancer survivors living in the U.S., and approximately 20% of these live in rural communities. Rural populations experience significant

barriers to healthcare access and there are persistent disparities in survivorship outcomes for rural cancer survivors. Survivorship care is complex and requires coordination across multiple domains and specialties. Though past research to improve survivorship outcomes has focused on patient and provider-level interventions such as treatment summaries and survivorship care

plans, these approaches remain under-utilized and have had lower than expected impact. The recently released National Standards for Cancer Survivorship Care (NSCSC) guide health systems in the design of policies, processes, and assessments to ensure high quality, accessible care for all cancer survivors. The overall goal of this study is to assess facilitators

and barriers to NSCSC implementation in rural health systems in Washington state. To achieve this goal, we will partner with four rural health systems in Washington state to conduct semi- structured interviews with key informants, such as clinicians (e.g. primary care providers, oncologists), leaders (e.g. medical directors, CEOs), clinical staff (e.g. nurses, behavioral health

providers), and non-clinical staff (e.g. health information technology staff, patient navigators). Rural health system partners will be identified and engaged through relationships with the Fred Hutch Cancer Center Office of Community Outreach and Engagement and the WWAMI region Practice and Research Network. The study is guided by the Health Equity Implementation

Framework (HEIF), which is an implementation science framework that integrates internal and external contextual factors with domains that influence health equity to ensure comprehensive identification of facilitators and barriers. Our team, comprised of an experienced rural health cancer control researcher and qualitative research scientist has demonstrated expertise in rural

health system engagement, qualitative research methods, and implementation science. The findings will guide design of strategies to support NSCSC implementation in rural health systems and will be critical in addressing rural cancer survivorship health disparities.