NEST Program addresses barriers rural cancer patients face to access supportive cancer care specialists in seven Middle Tennessee counties

Tennessee Oncology, a nationally recognized independent oncology practice with 35 clinics, has launched a community-based participatory research project to improve breast and prostate cancer patient access to three vital supportive care services via telehealth in seven rural counties in Middle Tennessee.

The seven counties are divided into three regions and include Robertson, Dickson, Putnam, Dekalb, Warren, Bedford and Coffee counties.

NEST (Navigated, Embedded, Supportive Care, Via Telehealth), which will be implemented through Tennessee Oncology’s McKay Institute for Oncology Transformation, is supported by a $1.5 million Practice Transformation and Extension grant from the Tennessee Department of Health to address barriers rural cancer patients face to see specialists for palliative care, psychology and integrative oncology services.

To kick off the program, Tennessee Oncology is recruiting Middle Tennessee cancer patients, caregivers, survivors, and patient advocates to participate in the program’s design as part of Community Advisory Boards (CABs).

CABs will help identify best practices to connect with cancer patients locally.

“Health care programs are often very one directional, but with NEST we will be empowering the community we intend to serve, to offer their perspectives on both challenges and solutions to shape the telehealth supportive services program,” said Sandhya Mudumbi, M.D., the medical director of Tennessee Oncology’s palliative care program. “By starting with people in the community, NEST will be an enduring, sustainable program that helps cancer patients in medically underserved communities get the supportive care they need and deserve.” 

Dr. Mudumbi serves as the program director for the project and will also lead region 3 (Warren, Bedford and Coffee counties). Working alongside her are Richard Martin III, M.D., Director of Health Equity and Community Engagement at Tennessee Oncology, leading Region 1 (Robertson and Dickson), and Johnetta Blakely, M.D., Executive Director for Health Economics and Outcomes Research, leading Region 2 (Putnam and Dekalb). 

“Developing supportive services with community-based participatory research has never been done before in community oncology, and we’re proud to be the first to undertake such an innovative and meaningful approach. This will help build a foundation where community engagement is incorporated into other important practice initiatives at Tennessee Oncology,” said Dr. Martin.

A lack of access to smartphones, broadband access, digital literacy, and cultural factors are all barriers that hamper patients living in rural and medically underserved communities from accessing supportive cancer care that can enhance their cancer care journey.

To overcome these barriers, Tennessee Oncology’s NEST consists of the following:

  • Navigated: Telehealth navigators will help patients understand the technology used in a telehealth visit with a doctor and improve patients’ comfort level with these digital telehealth tools.
  • Embedded: Embed telehealth workflows and equipment within seven Tennessee Oncology satellite clinics in Middle Tennessee counties so patients have the necessary broadband connection to have appointments with specialists without having to travel to Nashville or Clarksville to receive these specialized services. 
  • Supportive Care: Palliative care, psychology, and integrative oncology services, together incorporate patient-centered, evidenced-based practices including symptom management, lifestyle changes and counseling, and therapy to improve the patient and caregiver’s quality of life. Together they offer a therapeutic presence and support that enhances the cancer care journey for patients, caregivers, and oncologists.
  • Via Telehealth: Patients will have appointments via a laptop in private rooms staffed by certified Medical Assistants with supportive care physicians, advance practice providers, or psychologists and licensed counselors who are in different clinic locations.

During the Covid-19 pandemic when Tennessee Oncology rapidly deployed telehealth services, patient participation in palliative care, psychology and integrative oncology grew. And while about 40% of these service lines’ patients still have telemedicine appointments, patients in rural communities, who may be struggling financially and experiencing access barriers, often miss out on the full extent of telehealth and accessing these services.

In 2022, only 1.5% of breast cancer patients and 2.7% of prostate cancer patients accessed palliative care in rural and underserved Tennessee counties. None of these patients had a psychology or integrative oncology appointment. Tennessee Oncology will collaborate with University of Alabama-Birmingham’s Ronit Elk, Ph.D., a nationally renowned researcher who has deep expertise in community-based participatory research, and in developing culturally appropriate palliative care programs in the deep South, on this project.

The program’s year one goals including creating a solid foundation for community engagement by getting CABs organized for all three regions, holding CAB meetings organizing focus groups and developing the program through their input. 

“NEST was born from what we learned using telehealth to connect our patients with cancer care services during the pandemic,” said Natalie Dickson, MD, President and Chief Strategy Officer, Tennessee Oncology. “During the pandemic, practices quickly set up and used telehealth to connect patients to physicians and use of our supportive care services rose. With NEST, we will build on what we learned during the pandemic by engaging community members and building trustful relationships to create best practices that overcome technological and cultural barriers to using telehealth services so patients in hard-to-reach counties can get the cancer care services they need.”

Image by Freepik.

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