Navigated embedded supportive care via telehealth (NEST): A community-partnership model for rural oncology supportive care access.

Abstract

e13534 Background: Rural Tennessee experiences disproportionately high cancer morbidity and mortality, yet utilization of palliative and supportive oncology services remains low. Although these are available in rural clinics within Tennessee Oncology (TO), fewer than 5% of rural patients receiving oncologic treatment access these services. NEST (Navigated, Embedded, Supportive care via Telehealth) was developed to address this gap through implementation with full community partnership using community-based participatory research (CBPR) approach. Methods: With funding from Tennessee State Health Department, and the support of TO leadership, we established and partnered with 3 Community Advisory Boards (CAB) in 3 rural communities. Each CAB consisted of 8-10 community members that included people with breast cancer, caregivers, and community leaders. The CABs reviewed our project objectives, participated in focus group recruitment, reviewed focus group findings, and based on these, made programmatic recommendations which they then rank-ordered. Since the majority in rural Tennessee are white, we established a Latino CAB and a Black American CAB to ensure that their perspectives and recommendations are also incorporated into our final program. Results: Despite regional differences, all 3 CABs independently converged on 9 recommendations, with five rank-ordered as key: (1) Dedicated nurse navigation, (2) Repeated, multimodal patient and caregiver education, (3) Telehealth as an option, not a replacement for in-person care, (4) Expansion of supportive care services to include palliative care, psychosocial oncology, integrative medicine, peer support, support groups and spiritual care, and (5) Structured caregiver support with skills training and emotional guidance. We incorporated all top five community-based priorities into our program. Programmatic changes included (1) Deployment of nurse navigators, (2) Standardized education delivered through written material, in-person teaching, and videos, (3) Redesigned telehealth workflows preserving monthly in-person supportive care access, and (4) Expansion of supportive care offerings to include: (5) Caregiver support groups, peer networks, and on-demand spiritual care. (6) Cultural and linguistic adaptations, including Spanish-language navigation and materials were incorporated. Conclusions: Community partnerships across multiple rural regions were feasible to implement and sustain. All CABs revealed a convergence of priorities for supportive oncology care delivery. Translating these shared recommendations into our program, demonstrates that it is possible to build a supportive care framework that is responsive to the needs of rural communities. The CBPR partnership approach offers a scalable strategy to address persistent gaps in palliative and supportive care utilization.