Tailor Program Services to Local Needs and Resources

Key to Success 2 of Public Health Strategies to Help People with Cancer in Rural Communities

“They want us to present to the nursing staff so they can start referring ... cancer survivors. We’re also doing outreach with posters and social media content.”

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. For example, 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]

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]

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]

Insights from Pilot Sites

Understand and consider the needs and opportunities in your community when planning your program supports. For example, federally qualified health centers are well-connected with community resources and in-house referral programs. They may offer a good model for wrap-around 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 navigating
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.

More Keys to Success for Improving Care for People with Cancer in Rural Areas