Abstract A026: Expanding access to oncology navigation in rural Appalachia with a volunteer support model
Authors: Morris Bonny B. , Waugh Charlotte , Hege Adam , Anderson Maggie , Curry Woods , Benton Allison , Bell Ronny , Nightingale Chandylen 
Published: December 2023

Abstract
Background: Despite the benefits of patient navigation as an evidence-based practice for reducing health disparities in underserved communities, widespread implementation has proved challenging. Cost often limits the number of navigators a cancer center can hire and thus their depth of coverage, resulting in high caseloads or limited availability, particularly in rural-serving clinics. Successful utilization of college student volunteers to expand capacity in health clinics has been previously reported yet has not been extended to support oncology navigation. We employed implementation science methodology to determine barriers, facilitators, and implementation strategies for patent navigation to be supported by student volunteers in a community cancer center serving rural Appalachia. Methods: Leveraging Context-Driven Co-Design (CD2), we conducted clinic observations and key informant co-design sessions with a user-centered design context assessment form previously developed by our team. Co-design sessions were audio-recorded and transcribed. CFIR guided data collection and thematic analysis with inductive coding to identify contextual barriers and facilitators to include in the translation table and implementation model. Co-design sessions prioritized contextual factors in the implementation model, intervention adaptations to optimize fit, and implementation strategies to address the remaining friction, while iteratively refining the model. Results: We observed the radiation oncology and hematology oncology clinics in an Appalachian community cancer center. We conducted 7 key informant interviews with an oncologist, a cancer center director, a radiation oncology nurse, a hematology oncology nurse, a social worker, a financial navigator, and a patient. Facilitators included need (high caseload, patient population, transportation and information barriers), mission alignment (maximize patient support), and culture (high team cohesion). Barriers included available resources (physical space, time), work infrastructure (qualifications, maintaining clinic efficiency, role delineation), and access to knowledge and information (guidance and training). Implementation strategies selected were a rigorous volunteer screening process, training sessions designed and executed by volunteer organization leadership, a comprehensive training curriculum, and consideration of staff limitations (physical space, time, caseload, work infrastructure). Conclusion: The final proposed implementation model utilizes student volunteers to support oncology navigation adapted to contextual factors at a community cancer center serving rural Appalachia. This model extends navigation services in underserved, rural communities and can be leveraged in other similar oncology settings to support health equity. The American Cancer Society Community Access to Resources, Education, and Support (ACS CARES program) will be launching student volunteers to support navigation in a four-site pilot study in September 2023 utilizing the findings from this study to enhance implementation.
Citation Format: Bonny B. Morris, Charlotte Waugh, Adam Hege, Maggie Anderson, Woods Curry, Allison Benton, Ronny Bell, Chandylen Nightingale. Expanding access to oncology navigation in rural Appalachia with a volunteer support model [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A026.